{ "hospital_name": "Landmark Medical Center", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Landmark Medical Center" ], "hospital_address": [ "115 Cass Avenue Woonsocket, RI 02895" ], "license_information": { "license_number": "461175423", "state": "RI" }, "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": "Michael R. Souza" }, "type_2_npi": [ "1699752923", "1396722666" ], "standard_charge_information": [ { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9628.0, "minimum": 6917.0, "maximum": 17813.317, "payers_information": [ { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 15406.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 8569.65, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 9243.67, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8720.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9628.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9628.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9627.98 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 17813.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 8720.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 8720.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 9628.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8720.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8720.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9628.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 10110.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8894.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8720.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8894.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 9156.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12517.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 9628.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19547.0, "minimum": 9869.2, "maximum": 36162.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17657.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18010.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 18540.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25411.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 19547.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 31275.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17397.01, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 18765.31, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17657.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19547.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19547.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22761.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 36162.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 17657.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 17657.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 19547.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17657.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17657.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19547.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 20524.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18010.55, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8150.0, "minimum": 5173.8, "maximum": 56084.3044, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7388.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7536.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7758.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10596.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8150.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 13041.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7254.23, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7824.79, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7388.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8150.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8150.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5173.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 15079.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7388.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7388.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8150.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7388.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7388.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8150.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8558.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7536.35, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8960.0, "minimum": 7850.5, "maximum": 29327.1272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8280.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8523.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11648.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8960.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 14336.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7974.69, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8601.92, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8960.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8960.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12257.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 16576.61, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 8118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 8118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8960.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8960.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 9408.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8280.36, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 50719.0, "minimum": 21084.2, "maximum": 102716.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45745.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46660.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 48033.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 65935.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 50719.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 81151.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 45140.72, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 48691.11, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45745.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 50719.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 50719.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 102716.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 93831.83, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 45745.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 45745.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 50719.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 45745.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45745.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 50719.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 53255.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 46660.82, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Acetaminophen Iv Soln 10 Mg/Ml - 00781315695", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00781315695", "type": "NDC" }, { "code": "J0131", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 157.62, "10th_percentile": 157.62, "90th_percentile": 157.62, "count": "1 through 10" } ] } ] }, { "description": "Acetaminophen Iv Soln 10 Mg/Ml - 43825010201", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "43825010201", "type": "NDC" }, { "code": "J0131", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 157.62, "10th_percentile": 157.62, "90th_percentile": 157.62, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8863.0, "minimum": 5383.2, "maximum": 16518.4964, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8030.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8191.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8432.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11522.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8863.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 10800.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 14181.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7888.31, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8508.74, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8030.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8863.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8863.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11583.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 16397.05, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 8030.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 8030.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8863.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8030.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8030.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8863.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 9306.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8191.14, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11099.0, "minimum": 5445.62, "maximum": 30224.8964, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10045.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10246.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 10547.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14429.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 11099.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 17759.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 9878.56, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 10655.52, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10045.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11099.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11099.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5445.62 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 20534.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 10045.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 10045.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 11099.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10045.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10045.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11099.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 11654.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10246.41, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Acetylcholine Chloride Intraocular For Soln 20 Mg (1:100)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "24208053920", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9239.0, "minimum": 3155.6, "maximum": 17093.334, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8369.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8537.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8788.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12011.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 9239.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 14783.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 8223.28, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8870.05, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8369.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9239.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9239.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7409.35 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 17093.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 8369.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 8369.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 9239.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8369.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8369.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9239.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 9701.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8537.06, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Adenosine Iv Soln 3 Mg/Ml (Diagnostic) - 23155025832", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "23155025832", "type": "NDC" }, { "code": "J0153", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 826.65, "10th_percentile": 826.65, "90th_percentile": 826.65, "count": "1 through 10" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10758.0, "minimum": 8299.1, "maximum": 19903.8725, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9738.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9933.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 10225.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13986.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 10758.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 17214.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 9575.38, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 10328.5, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9738.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10758.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10758.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17592.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 19903.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 9738.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 9738.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 10758.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9738.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9738.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10758.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 11296.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9933.34, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16077.0, "minimum": 8686.16, "maximum": 29743.3195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14531.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14821.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 15257.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20900.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 16077.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 25723.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14308.95, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 15434.37, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14531.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16077.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16077.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8686.16 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 29743.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 14531.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 14531.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 16077.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14531.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14531.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16077.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 16881.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14821.62, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11614.0, "minimum": 5383.2, "maximum": 109749.4292, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10509.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10719.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 11034.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15098.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 11614.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 18582.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 10336.59, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 11149.58, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10509.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11614.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11614.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15909.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 21486.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 10509.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 10509.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 11614.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10509.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10509.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11614.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 12194.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10719.49, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13260.0, "minimum": 6492.0, "maximum": 79666.1656, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11992.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12232.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 12592.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17238.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 13260.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 21217.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 11801.98, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 12730.22, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11992.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13260.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13260.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18596.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 24532.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 11992.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 11992.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 13260.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11992.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11992.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13260.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 13923.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12232.66, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7808.0, "minimum": 6280.4, "maximum": 32548.1312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7079.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7221.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7433.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10150.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 7808.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 12493.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6949.41, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7496.0, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7079.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7808.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7808.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11269.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 14445.41, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7079.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7079.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 7808.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7079.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7079.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7808.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8198.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7221.58, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25228.0, "minimum": 16598.2, "maximum": 46672.651, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22776.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23232.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 23915.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 32797.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 25228.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 40365.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 22453.33, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 24219.32, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22776.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25228.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25228.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33725.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 46672.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 22776.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 22776.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 25228.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 22776.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22776.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 25228.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 26489.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23232.13, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7642.0, "minimum": 3492.06, "maximum": 17539.6232, "payers_information": [ { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7642.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8024.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7069.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6930.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7069.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7277.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9935.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 7642.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 12228.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6801.9, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7336.88, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6930.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7642.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7642.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3492.06 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 14138.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6930.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6930.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 7642.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6930.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6930.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11341.0, "minimum": 9869.2, "maximum": 27823.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10263.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10468.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 10776.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14743.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 11341.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 18146.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 10093.72, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 10887.61, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10263.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11341.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11341.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27823.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 20981.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 10263.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 10263.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 11341.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10263.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10263.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11341.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 11908.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10468.67, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42226.0, "minimum": 18610.4, "maximum": 78118.877, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38092.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38854.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 39997.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 54894.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 42226.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 67562.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 37581.51, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 40537.36, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38092.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42226.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42226.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 61182.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 78118.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 38092.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 38092.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 42226.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 38092.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38092.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 42226.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 44337.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38854.66, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15136.0, "minimum": 13471.1201, "maximum": 28001.7665, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13682.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13956.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 14366.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19676.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 15136.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 24217.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13471.12, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 14530.65, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13682.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15136.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15136.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17182.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 28001.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 13682.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 13682.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 15136.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13682.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13682.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15136.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 15892.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13956.35, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7068.0, "minimum": 3813.1, "maximum": 45249.3952, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6413.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6541.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 6733.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9188.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 7068.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 7650.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 9000.0, "count": "1 through 10" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 11309.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6290.89, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 6785.68, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6413.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7068.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7068.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10390.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 13076.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6413.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6413.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 7068.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6413.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6413.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7068.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 7421.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6541.54, "additional_payer_notes": "102.00% 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": 17524.0, "minimum": 11439.3, "maximum": 32420.029, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15834.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16151.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 16626.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22781.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 17524.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 28038.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15596.66, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 16823.37, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15834.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17524.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17524.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23240.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 32420.03, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 15834.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 15834.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 17524.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15834.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15834.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17524.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 18400.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16151.39, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18585.0, "minimum": 7177.6, "maximum": 34383.508, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16791.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17126.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 17630.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24161.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 18585.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 29737.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16541.26, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 17842.25, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16791.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18585.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18585.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31894.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 34383.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 16791.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 16791.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 18585.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16791.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16791.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18585.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 19514.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17126.82, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6785.0, "minimum": 3588.8, "maximum": 13681.2716, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6158.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6281.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 6466.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 8821.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 6785.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 10856.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6039.05, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 6514.03, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6158.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6785.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6785.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9277.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 12553.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6158.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6158.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 6785.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6158.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6158.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6785.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 7124.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6281.47, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Albumin, Human Inj 25% - 68516521601", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "68516521601", "type": "NDC" }, { "code": "P9047", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 53.0, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 198.27, "10th_percentile": 198.27, "90th_percentile": 396.54, "count": "12" } ] } ] }, { "description": "Alcohol Absolute Inj 98%", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "17478050305", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5931.0, "minimum": 2915.9, "maximum": 50549.2032, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5388.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5496.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 5657.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 7710.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 5931.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 9489.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 5278.65, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 5693.83, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5388.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5931.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5931.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7029.23 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 10972.48, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 5388.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 5388.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 5931.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5388.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5388.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5931.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 6227.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5496.22, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6095.0, "minimum": 4351.54, "maximum": 11277.415, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5536.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5647.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 5813.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 7924.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 6095.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 9753.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 5425.35, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 5852.06, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5536.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6095.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6095.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4351.54 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 11277.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 5536.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 5536.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 6095.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5536.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5536.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6095.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 6400.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5647.71, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Adenosine Iv Soln 3 Mg/Ml (Diagnostic) - 00703877701", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "00703877701", "type": "NDC" }, { "code": "J0153", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 826.65, "10th_percentile": 826.65, "90th_percentile": 826.65, "count": "1 through 10" } ] } ] }, { "description": "Alteplase For Inj 2 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50242004164", "type": "NDC" }, { "code": "J2997", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 93.0, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 788.81, "10th_percentile": 788.81, "90th_percentile": 788.81, "count": "1 through 10" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20517.0, "minimum": 6056.1, "maximum": 37958.0965, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18532.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18902.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 19458.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26673.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 20517.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 32828.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 18260.92, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 19697.17, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18532.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20517.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20517.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30664.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 37958.1, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 18532.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 18532.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 20517.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 18532.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18532.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20517.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 21543.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18902.64, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Adenosine Iv Soln 6 Mg/2Ml", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "63323065102", "type": "NDC" }, { "code": "J0153", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 826.65, "10th_percentile": 826.65, "90th_percentile": 826.65, "count": "1 through 10" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13409.0, "minimum": 8301.53, "maximum": 34200.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12127.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12369.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 12733.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17432.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 13409.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 21455.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 11934.83, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 12873.52, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12127.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13409.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13409.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8301.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 24808.35, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 12127.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 12127.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 13409.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12127.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12127.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13409.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 14080.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12369.85, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Albumin, Human Inj 25% - 00944049301", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00944049301", "type": "NDC" }, { "code": "P9047", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 53.0, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 198.27, "10th_percentile": 198.27, "90th_percentile": 396.54, "count": "12" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15845.0, "minimum": 8299.1, "maximum": 29314.693, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14322.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14608.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 15038.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20599.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 15845.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 25353.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14102.74, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 15211.95, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14322.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17367.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 29314.69, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 14322.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 14322.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 15845.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14322.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14322.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15845.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 16638.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14608.64, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16427.0, "minimum": 10766.4, "maximum": 30390.468, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14846.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15143.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 15588.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21355.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 16427.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 26283.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14620.28, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 15770.19, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14846.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16427.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16427.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13222.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 30390.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 14846.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 14846.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 16427.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14846.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14846.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16427.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 17248.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15143.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6194.0, "minimum": 5513.372, "maximum": 22213.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5626.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5738.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 5907.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 8053.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 6194.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 9911.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 5513.37, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 5947.01, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5626.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6194.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6194.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22213.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 11460.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 5626.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 5626.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 6194.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5626.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5626.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6194.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 6504.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5738.6, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6548.0, "minimum": 4037.4, "maximum": 35828.5296, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 5827.97, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 6286.35, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5944.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6548.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6548.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4982.05 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 12114.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 5944.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 5944.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 6548.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5944.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5944.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6548.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 6875.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6063.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5944.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6063.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 6241.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 8512.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 6548.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 10477.25, "additional_payer_notes": "160.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8530.0, "minimum": 7401.9, "maximum": 15782.0725, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7731.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7885.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8117.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11090.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8530.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 14850.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 54000.0, "10th_percentile": 54000.0, "90th_percentile": 54000.0, "count": "1 through 10" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 13649.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7592.46, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8189.62, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7731.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8530.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8530.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 15782.07, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7731.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7731.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8530.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7731.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7731.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8530.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8957.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7885.63, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33580.0, "minimum": 17744.8, "maximum": 139997.1696, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30301.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30907.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 31816.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 43654.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 33580.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 53728.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 29886.2, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 32236.8, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30301.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33580.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33580.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44661.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 62123.0, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 30301.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 30301.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 33580.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 30301.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30301.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 33580.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 35259.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30907.84, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 110499.0, "minimum": 98344.4838, "maximum": 204423.927, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 99610.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 101603.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 104591.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 143649.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 110499.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 176799.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 98344.48, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 106079.44, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 99610.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 110499.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 110499.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 132478.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 204423.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 99610.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 99610.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 110499.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 99610.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 99610.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 110499.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 116024.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 101603.02, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Alteplase For Inj 100 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50242008527", "type": "NDC" }, { "code": "J2997", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 93.0, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 788.81, "10th_percentile": 788.81, "90th_percentile": 788.81, "count": "1 through 10" } ] } ] }, { "description": "Alteplase For Inj 50 Mg - 50242004413", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50242004413", "type": "NDC" }, { "code": "J2997", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 93.0, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 788.81, "10th_percentile": 788.81, "90th_percentile": 788.81, "count": "1 through 10" } ] } ] }, { "description": "Alteplase For Inj 50 Mg - 09999999992", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "09999999992", "type": "NDC" }, { "code": "J2997", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 93.0, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 788.81, "10th_percentile": 788.81, "90th_percentile": 788.81, "count": "1 through 10" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8419.0, "minimum": 7357.6, "maximum": 34825.678, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7630.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7782.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8011.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10944.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8419.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 13470.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7493.03, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8082.36, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7630.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8419.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8419.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8324.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 15575.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7630.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7630.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8419.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7630.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7630.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8419.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8840.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7782.95, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ankle Arthroscopy/Surgery - 29898 - OR36029898", "code_information": [ { "code": "29898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9827.38, "discounted_cash": 3660.0, "minimum": 1324.0, "maximum": 9336.011, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4682.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 3047.36 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3843.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5125.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3902.4, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3254.44, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2764.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5854.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13124.0, "minimum": 11680.538, "maximum": 72936.3232, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12107.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 12463.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17061.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 13124.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 20998.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 11680.54, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 12599.23, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13124.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13124.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18904.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 24279.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 11869.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 13124.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13124.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 13780.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12107.3, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Toe & Metatarsal", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8800.36, "discounted_cash": 3660.0, "minimum": 1045.331, "maximum": 8360.342, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2844.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1851.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3843.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5125.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3902.4, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3254.44, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2031.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ankle Arthroscopy/Surgery - 29894 - OR36029894", "code_information": [ { "code": "29894", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9375.0, "discounted_cash": 3660.0, "minimum": 1324.0, "maximum": 8906.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4682.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 3047.36 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3843.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5125.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3902.4, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3254.44, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2764.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5854.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Aspirate/Inj Ganglion Cyst", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 343.0, "minimum": 112.042, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 437.32 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 284.64 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 350.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 360.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 480.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 366.09, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 305.3, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 263.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 112.04 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3774.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 350.29, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21286.0, "minimum": 18944.718, "maximum": 51986.0908, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19224.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19608.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 20185.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27672.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 21286.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 34057.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 18944.72, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 20434.75, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19224.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21286.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21286.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23583.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 39379.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 19224.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 19224.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 21286.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19224.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19224.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 21286.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 22350.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19608.79, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Atropine Sulfate Iv Soln 1 Mg/Ml", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "16729052608", "type": "NDC" }, { "code": "J0461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 20.06, "10th_percentile": 18.06, "90th_percentile": 54.19, "count": "15" } ] } ] }, { "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": 26549.0, "minimum": 23506.0, "maximum": 49117.2595, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23967.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24446.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 25165.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 34514.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 26549.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 42479.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 23629.38, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 25487.88, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23967.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26549.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26549.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23506.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 49117.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 23967.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 23967.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 26549.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 23967.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23967.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 26549.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 27877.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24446.54, "additional_payer_notes": "102.00% 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": 11254.0, "minimum": 9704.67, "maximum": 26960.4888, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10185.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10388.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 10694.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14630.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 11254.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 18006.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 10016.29, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 10804.09, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10185.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11254.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11254.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9704.67 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 20820.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 10185.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 10185.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 11254.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10185.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10185.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11254.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 11816.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10388.7, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17312.0, "maximum": 69000.302, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21993.4 } ] } ] }, { "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": 45516.0, "minimum": 40509.8452, "maximum": 84205.858, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41057.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41878.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 43110.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 59171.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 45516.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 72826.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 40509.85, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 43696.01, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 41057.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45516.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45516.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44636.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 84205.86, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 41057.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 41057.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 45516.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 41057.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41057.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 45516.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 47792.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41878.65, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32382.0, "minimum": 27694.0, "maximum": 59907.107, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32382.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32382.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27694.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 59907.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 29222.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 29222.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 32382.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 29222.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29222.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 32382.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 34001.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29806.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29222.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29806.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 30683.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 42096.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 32382.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 51811.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 28820.18, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 31086.93, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29222.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6611.0, "minimum": 4037.4, "maximum": 35997.5752, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6001.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6121.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 6301.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 8594.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 6611.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 10578.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 5884.2, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 6347.0, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6001.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6611.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6611.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5876.49 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 12231.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6001.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6001.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 6611.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6001.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6001.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6611.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 6942.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6121.55, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39758.0, "minimum": 35385.065, "maximum": 98067.0076, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35869.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36586.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 37662.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 51686.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 39758.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 63613.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 35385.07, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 38168.16, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35869.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39758.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39758.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65063.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 73553.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 35869.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 35869.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 39758.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 35869.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35869.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 39758.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 41746.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36586.38, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Thru Metatarsal", "code_information": [ { "code": "28805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9913.22, "discounted_cash": 3660.0, "minimum": 1251.0, "maximum": 9417.559, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4682.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 3047.36 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3843.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5125.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3902.4, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3254.44, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Atracurium Besylate Preservative Free (Pf) Iv Soln 50 Mg/5Ml", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00409110901", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "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": 17573.0, "minimum": 15640.6731, "maximum": 32511.5115, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15879.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16196.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 16673.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22845.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 17573.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 28118.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15640.67, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 16870.84, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15879.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17573.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17573.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17145.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 32511.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 15879.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 15879.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 17573.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15879.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15879.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17573.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 18452.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16196.78, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ankle Arthroscopy/Surgery - 29891 - OR36029891", "code_information": [ { "code": "29891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10053.6, "discounted_cash": 3660.0, "minimum": 1045.331, "maximum": 9550.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4682.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 3047.36 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3843.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5125.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3902.4, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3254.44, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4625.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6315.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Atropine Sulfate Inj 0.1 Mg/Ml", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "76329333901", "type": "NDC" }, { "code": "J0461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 20.06, "10th_percentile": 18.06, "90th_percentile": 54.19, "count": "15" } ] } ] }, { "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": 13434.0, "minimum": 11956.8296, "maximum": 65959.7656, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12149.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12392.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 12757.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17465.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 13434.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 21495.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 11956.83, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 12897.25, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12149.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13434.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13434.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15589.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 24854.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 12149.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 12149.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 13434.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12149.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12149.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13434.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 14106.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12392.59, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery", "code_information": [ { "code": "29895", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3700.89, "discounted_cash": 3660.0, "minimum": 1110.267, "maximum": 3700.89, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2764.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3700.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3700.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 3700.89 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 3047.36 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3700.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3700.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3700.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3700.89, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3254.44, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Atropine Sulfate Soln Prefill Syr 0.25 Mg/5Ml (0.05 Mg/Ml)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00409963015", "type": "NDC" }, { "code": "J0461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 20.06, "10th_percentile": 18.06, "90th_percentile": 54.19, "count": "15" } ] } ] }, { "description": "Bacitracin Intramuscular For Soln 50000 Unit", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00009023301", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Amputation Of Toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7670.0, "discounted_cash": 3660.0, "minimum": 1045.331, "maximum": 7286.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2844.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1851.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3843.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5125.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3902.4, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3254.44, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2031.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% 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": 39120.0, "minimum": 6492.0, "maximum": 120531.7972, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35293.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35999.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 37058.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 50856.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 39120.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 62592.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 34817.0, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 37555.42, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35293.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39120.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39120.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7736.44 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 72372.43, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 35293.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 35293.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 39120.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 35293.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35293.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 39120.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 41076.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35999.78, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Atropine Sulfate Soln Prefill Syr 0.5 Mg/5Ml (0.1 Mg/Ml) - 76329333901", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "76329333901", "type": "NDC" }, { "code": "J0461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 20.06, "10th_percentile": 18.06, "90th_percentile": 54.19, "count": "15" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18763.0, "minimum": 13849.6, "maximum": 34712.1605, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16951.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17290.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 17798.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24392.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 18763.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 30021.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16699.36, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 18012.8, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16951.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18763.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18763.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25135.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 34712.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 16951.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 16951.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 18763.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16951.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16951.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18763.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 19701.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17290.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12431.0, "minimum": 11064.3999, "maximum": 56924.9636, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11246.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11471.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 11808.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16161.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 12431.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 19891.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 11064.4, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 11934.63, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11246.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12431.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12431.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15157.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 22999.03, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 11246.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 11246.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 12431.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11246.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11246.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12431.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 13053.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11471.02, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 50192.0, "minimum": 36560.9, "maximum": 92856.014, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45270.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46176.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 47534.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 65250.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 50192.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 80307.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 44671.27, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 48184.74, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45270.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 50192.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 50192.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 75568.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 92856.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 45270.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 45270.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 50192.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 45270.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45270.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 50192.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 52702.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 46176.01, "additional_payer_notes": "102.00% 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": 14126.0, "minimum": 8656.0, "maximum": 65566.8488, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13028.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 13412.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18365.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 14126.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 22603.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 12572.98, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 13561.86, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14126.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14126.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19692.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 26134.84, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 12773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 12773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 14126.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14126.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 14833.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13028.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21468.0, "minimum": 19106.9027, "maximum": 39716.5955, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19776.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 20357.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27908.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 21468.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 34349.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 19106.9, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 20609.69, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21468.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21468.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29631.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 39716.6, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 19388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 19388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 21468.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 21468.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 22541.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19776.27, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Atezolizumab Iv Soln 1200 Mg/20Ml", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "50242091701", "type": "NDC" }, { "code": "J9022", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 93.0, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 47932.74, "10th_percentile": 47932.74, "90th_percentile": 50851.83, "count": "17" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6874.0, "minimum": 4486.0, "maximum": 47634.3088, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6238.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6363.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 6550.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 8936.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 6874.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 10998.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6118.11, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 6599.31, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6238.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6874.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6874.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7446.57 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 12717.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6238.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6238.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 6874.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6238.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6238.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6874.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 7217.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6363.11, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Atropine Sulfate Soln Prefill Syr 0.5 Mg/5Ml (0.1 Mg/Ml) - 00409491034", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00409491034", "type": "NDC" }, { "code": "J0461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 20.06, "10th_percentile": 18.06, "90th_percentile": 54.19, "count": "15" } ] } ] }, { "description": "Azithromycin For Susp 200 Mg/5Ml", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "59762314001", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 17.78, "10th_percentile": 17.78, "90th_percentile": 17.78, "count": "1 through 10" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 20.75, "10th_percentile": 20.75, "90th_percentile": 20.75, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 8.93, "10th_percentile": 8.93, "90th_percentile": 8.93, "count": "1 through 10" } ] } ] }, { "description": "Ankle Arthroscopy/Surgery - 29897 - OR36029897", "code_information": [ { "code": "29897", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9375.0, "discounted_cash": 3660.0, "minimum": 1324.0, "maximum": 8906.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4682.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 3047.36 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3843.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5125.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3902.4, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3254.44, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2764.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5854.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Betamethasone Sod Phosphate & Acetate Inj Susp 6 (3-3) Mg/Ml", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00517072001", "type": "NDC" }, { "code": "J0702", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 93.78, "10th_percentile": 93.78, "90th_percentile": 93.78, "count": "1 through 10" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 63430.0, "minimum": 17019.3, "maximum": 117346.203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 57198.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 58342.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 60058.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 82459.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 63430.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 101488.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 56453.04, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 60893.16, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 57198.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 63430.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 63430.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17019.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 117346.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 57198.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 57198.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 63430.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 57198.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 57198.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 63430.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 66601.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 58342.78, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Azithromycin Tab 250 Mg - 50111078710", "drug_information": { "unit": 30.0, "type": "EA" }, "code_information": [ { "code": "50111078710", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 17.78, "10th_percentile": 17.78, "90th_percentile": 17.78, "count": "1 through 10" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 20.75, "10th_percentile": 20.75, "90th_percentile": 20.75, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 8.93, "10th_percentile": 8.93, "90th_percentile": 8.93, "count": "1 through 10" } ] } ] }, { "description": "Appendectomy", "code_information": [ { "code": "44950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11982.2, "discounted_cash": 7243.0, "minimum": 1045.331, "maximum": 11383.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7243.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 5106.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 3323.36 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7387.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 7605.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10140.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7243.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7721.12, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6439.1, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7243.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7243.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7243.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7243.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 7243.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7243.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 7243.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5854.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7243.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7243.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7387.94, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Aztreonam Iv Syringe In Sw", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "99999040126", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Aztreonam For Inj 1 Gm - 00003256016", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00003256016", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "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": 33098.0, "minimum": 29457.5137, "maximum": 81452.5664, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29867.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30465.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 31361.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 43027.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 33098.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 52957.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 29457.51, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 31774.4, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29867.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33098.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33098.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65785.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 61231.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 29867.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 29867.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 33098.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 29867.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29867.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 33098.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 34753.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30465.16, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14307.0, "minimum": 12733.5326, "maximum": 34576.6784, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12936.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13194.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 13582.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18599.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 14307.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 22891.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 12733.53, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 13735.05, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12936.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14307.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14307.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29498.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 26468.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 12936.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 12936.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 14307.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12936.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12936.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14307.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 15022.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13194.72, "additional_payer_notes": "102.00% 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": 24065.0, "minimum": 12336.5, "maximum": 44521.1195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21728.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22163.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 22815.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31285.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 24065.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 38504.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 21418.27, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 23102.85, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21728.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24065.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24065.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21968.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 44521.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 21728.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 21728.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 24065.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 21728.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21728.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 24065.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 25268.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22163.17, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Aztreonam For Inj 1 Gm - 63323040120", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63323040120", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Biopsy Of Penis", "code_information": [ { "code": "54100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6356.25, "discounted_cash": 1847.0, "minimum": 519.96, "maximum": 6038.4375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1841.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1198.26 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1494.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22377.0, "minimum": 11439.3, "maximum": 54709.0956, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20207.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20612.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 21218.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29091.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 22377.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 35804.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 19916.21, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 21482.65, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20207.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22377.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22377.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32805.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 41398.86, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 20207.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 20207.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 22377.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 20207.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20207.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22377.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 23496.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20612.06, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Aztreonam For Inj 2 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63323040230", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10929.0, "minimum": 8223.2, "maximum": 26149.5268, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9892.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10089.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 10386.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14207.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 10929.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 17486.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 9726.97, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 10492.01, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9892.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10929.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10929.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18974.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 20218.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 9892.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 9892.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 10929.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9892.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9892.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10929.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 11475.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10089.88, "additional_payer_notes": "102.00% 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": 34670.0, "minimum": 23371.2, "maximum": 64140.7025, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31284.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31910.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 32848.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 45071.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 34670.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 55473.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 30856.88, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 33283.82, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 31284.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34670.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34670.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37168.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 64140.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 31284.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 31284.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 34670.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 31284.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31284.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 34670.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 36404.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31910.19, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8048.0, "minimum": 6273.52, "maximum": 30195.1992, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7296.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7442.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7660.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10462.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8048.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 12877.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7162.95, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7726.33, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7296.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8048.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8048.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6273.52 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 14889.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7296.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7296.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8048.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7296.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7296.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8048.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8450.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7442.08, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Appl Mltpln Uni Ext Fixj Sys", "code_information": [ { "code": "20692", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8625.0, "discounted_cash": 14364.0, "minimum": 1324.0, "maximum": 8625.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8625.0 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 8625.0 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2808.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 8625.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5854.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24065.0, "minimum": 12336.5, "maximum": 52424.6956, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21728.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22163.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 22815.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31285.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 24065.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 38504.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 21418.27, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 23102.85, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21728.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24065.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24065.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28729.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 44521.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 21728.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 21728.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 24065.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 21728.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21728.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 24065.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 25268.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22163.17, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20049.0, "minimum": 14715.2, "maximum": 44068.3604, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18110.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18472.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 19015.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26064.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 20049.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 32079.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17844.46, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 19247.95, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18110.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20049.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20049.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36068.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 37092.41, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 18110.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 18110.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 20049.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 18110.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18110.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20049.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 21052.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18472.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Arthrodesis Pantalar", "code_information": [ { "code": "28705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18816.1, "discounted_cash": 19617.0, "minimum": 1423.0, "maximum": 18816.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18816.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18816.1 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 13404.95 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18816.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 18816.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18816.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18816.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18816.1, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 17439.78, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18816.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4444.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18816.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18816.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18816.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 18816.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18816.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 18816.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6315.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18816.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18816.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18816.1, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24805.0, "minimum": 9521.6, "maximum": 60765.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22395.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22843.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 23515.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 32246.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 24805.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 39688.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 22076.79, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 23813.16, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22395.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24805.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24805.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26802.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 45889.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 22395.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 22395.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 24805.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 22395.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22395.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 24805.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 26045.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22843.21, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18112.0, "minimum": 9521.6, "maximum": 44209.9932, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16364.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16691.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 17182.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23545.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 18112.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 28979.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16119.89, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 17387.75, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16364.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18112.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18112.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34117.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 33507.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 16364.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 16364.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 18112.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16364.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16364.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18112.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 19017.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16691.69, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Arthrodesis Subtalar", "code_information": [ { "code": "28725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12880.9, "discounted_cash": 14364.0, "minimum": 1423.0, "maximum": 12880.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12880.9 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 8986.01 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12880.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12880.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12880.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12880.9, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12769.83, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4444.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6315.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12880.9, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22966.0, "minimum": 20440.2562, "maximum": 56177.9648, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20738.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21153.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 21775.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29856.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 22966.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 36746.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 20440.26, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 22047.92, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20738.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22966.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22966.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22481.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 42488.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 20738.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 20738.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 22966.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 20738.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20738.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22966.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 24114.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21153.27, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11162.0, "minimum": 8747.7, "maximum": 20650.9765, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 20650.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 10102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 10102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 11162.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11162.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 11720.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10304.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10304.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 10607.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14511.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 11162.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 17860.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 9934.79, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 10716.18, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11162.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11162.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15807.9 } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11404.0, "minimum": 6280.4, "maximum": 21098.214, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10320.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10526.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 10836.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14825.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 11404.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 18247.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 10149.95, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 10948.26, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10320.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11404.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11404.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14564.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 21098.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 10320.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 10320.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 11404.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10320.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10320.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11404.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 11974.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10526.71, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSYREMOVAL LYMPH NODES", "code_information": [ { "code": "38525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3560.86, "discounted_cash": 4380.0, "minimum": 1045.331, "maximum": 3560.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 3560.86 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2783.21 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2226.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3560.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3560.86, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51023.0, "minimum": 30728.8, "maximum": 126167.412, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 46019.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46939.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 48319.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 66329.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 51023.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 81636.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 45410.49, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 48982.1, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 46019.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51023.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51023.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 76830.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 94392.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 46019.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 46019.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 51023.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 46019.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 46019.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 51023.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 53574.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 46939.38, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Atropine Sulfate Inj 1 Mg/Ml", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00517101025", "type": "NDC" }, { "code": "J0461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 20.06, "10th_percentile": 18.06, "90th_percentile": 54.19, "count": "15" } ] } ] }, { "description": "Bivalirudin Trifluoroacetate For Iv Soln 250 Mg (Base Equiv) - 00409830020", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00409830020", "type": "NDC" }, { "code": "J0583", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4037.31, "10th_percentile": 4037.31, "90th_percentile": 4037.31, "count": "1 through 10" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14985.0, "minimum": 13337.451, "maximum": 36269.4188, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13547.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13818.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 14224.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19481.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 14985.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 23977.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13337.45, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 14386.46, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13547.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14985.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14985.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23380.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 27723.92, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 13547.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 13547.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 14985.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13547.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13547.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14985.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 15735.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13818.35, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Hcl Preservative Free (Pf) Inj 0.5% - 00409116201", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00409116201", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 26.82, "10th_percentile": 26.82, "90th_percentile": 41.1, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.23, "10th_percentile": 2.49, "90th_percentile": 19.67, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "median_amount": 42.14, "10th_percentile": 42.14, "90th_percentile": 42.14, "count": "1 through 10" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54747.0, "minimum": 36560.9, "maximum": 101282.5605, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 49374.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50362.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 51843.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 71171.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 54747.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 87595.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 48725.12, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 52557.44, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 49374.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54747.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54747.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56654.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 101282.56, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 49374.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 49374.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 54747.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 49374.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 49374.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 54747.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 57484.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 50362.3, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Bivalirudin Trifluoroacetate For Iv Soln 250 Mg (Base Equiv) - 65293099999", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "65293099999", "type": "NDC" }, { "code": "J0583", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4037.31, "10th_percentile": 4037.31, "90th_percentile": 4037.31, "count": "1 through 10" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17469.0, "minimum": 14282.4, "maximum": 42464.7116, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15785.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16100.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 16574.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22710.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 17469.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 27951.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15547.76, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 16770.61, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15785.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17469.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17469.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18890.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 32318.37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 15785.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 15785.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 17469.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15785.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15785.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17469.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 18342.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16100.9, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Hcl Preservative Free (Pf) Inj 0.5% - 63323046617", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323046617", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 26.82, "10th_percentile": 26.82, "90th_percentile": 41.1, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.23, "10th_percentile": 2.49, "90th_percentile": 19.67, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "median_amount": 42.14, "10th_percentile": 42.14, "90th_percentile": 42.14, "count": "1 through 10" } ] } ] }, { "description": "Azithromycin Tab 250 Mg - 59762306003", "drug_information": { "unit": 50.0, "type": "EA" }, "code_information": [ { "code": "59762306003", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 17.78, "10th_percentile": 17.78, "90th_percentile": 17.78, "count": "1 through 10" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 20.75, "10th_percentile": 20.75, "90th_percentile": 20.75, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 8.93, "10th_percentile": 8.93, "90th_percentile": 8.93, "count": "1 through 10" } ] } ] }, { "description": "Bivalirudin Trifluoroacetate For Iv Soln 250 Mg (Base Equiv) - 00781315895", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00781315895", "type": "NDC" }, { "code": "J0583", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4037.31, "10th_percentile": 4037.31, "90th_percentile": 4037.31, "count": "1 through 10" } ] } ] }, { "description": "Butorphanol Tartrate Inj 1 Mg/Ml", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00409162301", "type": "NDC" }, { "code": "J0595", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 59.07, "10th_percentile": 29.54, "90th_percentile": 88.04, "count": "1 through 10" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32675.0, "minimum": 17719.7, "maximum": 82507.9592, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29486.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30076.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 30960.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 42477.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 32675.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 52280.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 29080.97, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 31368.24, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29486.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32675.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32675.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37219.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 60449.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 29486.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 29486.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 32675.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 29486.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29486.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 32675.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 34309.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30076.33, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Bone Biopsy Open Superficial", "code_information": [ { "code": "20240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 3249.0, "minimum": 1045.331, "maximum": 6717.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2052.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Butorphanol Tartrate Inj 2 Mg/Ml - 00409162602", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409162602", "type": "NDC" }, { "code": "J0595", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 59.07, "10th_percentile": 29.54, "90th_percentile": 88.04, "count": "1 through 10" } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19451.0, "minimum": 5184.2, "maximum": 35984.4425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17570.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17922.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 18449.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25286.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 19451.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 31121.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17311.43, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 18673.01, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17570.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19451.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19451.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13847.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 35984.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 17570.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 17570.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 19451.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17570.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17570.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19451.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 20423.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17922.22, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12317.0, "minimum": 9196.3, "maximum": 22787.264, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11143.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11365.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 11700.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16012.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 12317.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 19707.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 10962.52, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 11824.74, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11143.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12317.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12317.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16351.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 22787.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 11143.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 11143.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 12317.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11143.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11143.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12317.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 12933.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11365.86, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9340.0, "minimum": 6504.7, "maximum": 41827.364, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8460.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8629.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8883.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12142.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 9340.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 14944.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 8312.93, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8966.76, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8460.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9340.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9340.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8250.78 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 17279.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 8460.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 8460.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 9340.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8460.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8460.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9340.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 9807.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8629.64, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine 0.75% In Dextrose Inj 8.25%", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409361301", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 26.82, "10th_percentile": 26.82, "90th_percentile": 41.1, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.23, "10th_percentile": 2.49, "90th_percentile": 19.67, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "median_amount": 42.14, "10th_percentile": 42.14, "90th_percentile": 42.14, "count": "1 through 10" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6582.0, "minimum": 4710.3, "maximum": 21498.4884, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5975.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6094.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 6273.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 8556.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 6582.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9450.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 9000.0, "count": "1 through 10" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 10531.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 5858.12, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 6318.87, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5975.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6582.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6582.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5332.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 12177.0, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 5975.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 5975.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 6582.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5975.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5975.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6582.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 6911.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6094.62, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Calcium Chloride Inj 10%", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00409492834", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7058.0, "minimum": 4394.4, "maximum": 33875.3676, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6404.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6532.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 6724.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9175.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 7058.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 11293.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6281.92, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 6776.01, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6404.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7058.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7058.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4394.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 13057.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6404.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6404.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 7058.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6404.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6404.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7058.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 7411.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6532.27, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Hcl Inj 0.25%", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00409158750", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 26.82, "10th_percentile": 26.82, "90th_percentile": 41.1, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.23, "10th_percentile": 2.49, "90th_percentile": 19.67, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "median_amount": 42.14, "10th_percentile": 42.14, "90th_percentile": 42.14, "count": "1 through 10" } ] } ] }, { "description": "Bupivacaine Hcl Inj 0.5% - 00409161050", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00409161050", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 26.82, "10th_percentile": 26.82, "90th_percentile": 41.1, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.23, "10th_percentile": 2.49, "90th_percentile": 19.67, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "median_amount": 42.14, "10th_percentile": 42.14, "90th_percentile": 42.14, "count": "1 through 10" } ] } ] }, { "description": "Carboplatin Iv Soln 150 Mg/15Ml - 00703424681", "drug_information": { "unit": 15.0, "type": "ML" }, "code_information": [ { "code": "00703424681", "type": "NDC" }, { "code": "J9045", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 143.14, "10th_percentile": 100.59, "90th_percentile": 211.26, "count": "1 through 10" } ] } ] }, { "description": "Bevacizumab-Awwb Iv Soln 100 Mg/4Ml (For Infusion)", "drug_information": { "unit": 4.0, "type": "ML" }, "code_information": [ { "code": "55513020601", "type": "NDC" }, { "code": "Q5107", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 23.0, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 6687.77, "10th_percentile": 2229.26, "90th_percentile": 11889.21, "count": "37" } ] } ] }, { "description": "Bupivacaine Hcl Inj 0.5% - 63323046757", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "63323046757", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 26.82, "10th_percentile": 26.82, "90th_percentile": 41.1, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.23, "10th_percentile": 2.49, "90th_percentile": 19.67, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "median_amount": 42.14, "10th_percentile": 42.14, "90th_percentile": 42.14, "count": "1 through 10" } ] } ] }, { "description": "Bupivacaine Hcl Preservative Free (Pf) Inj 0.25% - 00409115901", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00409115901", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 26.82, "10th_percentile": 26.82, "90th_percentile": 41.1, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.23, "10th_percentile": 2.49, "90th_percentile": 19.67, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "median_amount": 42.14, "10th_percentile": 42.14, "90th_percentile": 42.14, "count": "1 through 10" } ] } ] }, { "description": "Carboprost Tromethamine Im Soln 250 Mcg/Ml - 00009085605", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00009085605", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20385.0, "minimum": 18142.7479, "maximum": 49738.2412, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18412.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18780.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 19333.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26500.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 20385.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 32616.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 18142.75, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 19569.71, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18412.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20385.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20385.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30558.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 37712.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 18412.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 18412.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 20385.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 18412.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18412.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20385.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 21404.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18780.65, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Hcl Preservative Free (Pf) Inj 0.25% - 55150016710", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "55150016710", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 26.82, "10th_percentile": 26.82, "90th_percentile": 41.1, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.23, "10th_percentile": 2.49, "90th_percentile": 19.67, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "median_amount": 42.14, "10th_percentile": 42.14, "90th_percentile": 42.14, "count": "1 through 10" } ] } ] }, { "description": "Bupivacaine Hcl Preservative Free (Pf) Inj 0.75%", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00409158210", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 26.82, "10th_percentile": 26.82, "90th_percentile": 41.1, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.23, "10th_percentile": 2.49, "90th_percentile": 19.67, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "median_amount": 42.14, "10th_percentile": 42.14, "90th_percentile": 42.14, "count": "1 through 10" } ] } ] }, { "description": "Carboprost Tromethamine Im Soln 250 Mcg/Ml - 00009085608", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00009085608", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32081.0, "minimum": 28552.8465, "maximum": 78916.8824, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28951.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29530.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 30399.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 41706.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 32081.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 51330.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 28552.85, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 30798.58, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 28951.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32081.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32081.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50384.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 59351.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 28951.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 28951.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 32081.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 28951.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28951.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 32081.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 33685.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29530.94, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Butorphanol Tartrate Inj 2 Mg/Ml - 00409162601", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00409162601", "type": "NDC" }, { "code": "J0595", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 59.07, "10th_percentile": 29.54, "90th_percentile": 88.04, "count": "1 through 10" } ] } ] }, { "description": "Bupivacaine Inj 0.5% W/ Epinephrine 1:200000 (Pf) - 00409174929", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "00409174929", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42740.0, "minimum": 14282.4, "maximum": 127154.2728, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38555.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39326.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 40483.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 55562.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 42740.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 68384.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 38038.73, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 41030.54, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38555.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42740.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42740.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60429.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 79069.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 38555.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 38555.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 42740.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 38555.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38555.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 42740.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 44877.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 39326.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes", "code_information": [ { "code": "38500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 4380.0, "minimum": 1045.331, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4276.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2783.21 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4468.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4599.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6132.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4669.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3894.43, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2226.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4468.3, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4614.0, "minimum": 2467.3, "maximum": 16440.8268, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 4201.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 4285.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 4412.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 5998.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 4614.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 7382.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 4106.66, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 4429.66, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4201.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4614.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4614.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5530.23 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 8536.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 4201.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 4201.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 4614.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 4201.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4201.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 4614.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 4844.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 4285.94, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Inj 0.5% W/ Epinephrine 1:200000 (Pf) - 00409904517", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "00409904517", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17758.0, "minimum": 12984.0, "maximum": 37233.4356, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16045.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16366.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 16848.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23086.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 17758.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 28414.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15805.3, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 17048.41, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16045.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17758.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17758.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31289.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 32853.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 16045.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 16045.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 17758.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16045.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16045.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17758.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 18646.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16366.82, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Bivalirudin For Iv Soln 250 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00409830020", "type": "NDC" }, { "code": "J0583", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4037.31, "10th_percentile": 4037.31, "90th_percentile": 4037.31, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7183.0, "minimum": 5158.9, "maximum": 19910.8304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6517.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6647.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 6843.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9338.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 7183.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 11494.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6393.58, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 6896.45, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6517.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7183.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7183.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5988.16 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 13290.03, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6517.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6517.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 7183.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6517.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6517.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7183.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 7542.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6647.57, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Bx Of Cervix W/Scope Leep", "code_information": [ { "code": "57460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 3621.0, "minimum": 519.96, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 3637.57 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2367.55 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3694.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3802.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5070.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3860.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3219.76, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1859.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3694.22, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15372.0, "minimum": 8656.0, "maximum": 69843.2456, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14173.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 14590.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19984.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 15372.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 24595.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13681.39, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 14757.46, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15372.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15372.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19003.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 28438.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 13895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 13895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 15372.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15372.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 16140.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14173.51, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Bivalirudin Trifluoroacetate For Iv Soln 250 Mg (Base Equiv) - 65293000101", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "65293000101", "type": "NDC" }, { "code": "J0583", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4037.31, "10th_percentile": 4037.31, "90th_percentile": 4037.31, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11472.0, "minimum": 7626.2, "maximum": 21223.5885, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10589.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 10900.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14913.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 11472.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 18355.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 10210.27, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 11013.32, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11472.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11472.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10817.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 21223.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 10381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 10381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 11472.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11472.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 12045.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10589.03, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29220.0, "minimum": 20774.4, "maximum": 54057.3145, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26373.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26900.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 27691.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 37986.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 29220.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 46752.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 26005.95, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 28051.36, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26373.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29220.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29220.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35124.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 54057.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 26373.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 26373.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 29220.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 26373.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26373.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 29220.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 30681.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26900.77, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For Inj 1 Gm - 00143992490", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00143992490", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 19.69, "10th_percentile": 19.69, "90th_percentile": 19.69, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 11.65, "10th_percentile": 5.83, "90th_percentile": 17.48, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46601.0, "minimum": 13416.8, "maximum": 113018.4056, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 42035.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42876.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 44137.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 60582.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 46601.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 74562.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 41475.63, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 44737.76, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 42035.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46601.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46601.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49215.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 86213.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 42035.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 42035.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 46601.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 42035.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 42035.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 46601.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 48931.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 42876.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For Inj 1 Gm - 00409080501", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00409080501", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 19.69, "10th_percentile": 19.69, "90th_percentile": 19.69, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 11.65, "10th_percentile": 5.83, "90th_percentile": 17.48, "count": "1 through 10" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18237.0, "minimum": 5193.6, "maximum": 44381.3232, "payers_information": [ { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 18237.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 29180.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16231.55, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 17508.19, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16477.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18237.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18237.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25386.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 33739.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 16477.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 16477.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 18237.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16477.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16477.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18237.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 19149.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16807.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16477.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16807.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 17301.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23709.01, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "Calcium Gluconate Inj 10% - 63323031119", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323031119", "type": "NDC" }, { "code": "J0612", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "median_amount": 80.53, "10th_percentile": 80.53, "90th_percentile": 80.53, "count": "1 through 10" } ] } ] }, { "description": "Cefazolin Sodium-Dextrose Iv Solution 2 Gm/100Ml-4%", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338350841", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 19.69, "10th_percentile": 19.69, "90th_percentile": 19.69, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 11.65, "10th_percentile": 5.83, "90th_percentile": 17.48, "count": "1 through 10" } ] } ] }, { "description": "Caffeine & Sodium Benzoate Inj 125-125 Mg/Ml (500 Mg/2Ml)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00517250210", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Cefazolin Sodium For Iv Soln 3 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00143914025", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 19.69, "10th_percentile": 19.69, "90th_percentile": 19.69, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 11.65, "10th_percentile": 5.83, "90th_percentile": 17.48, "count": "1 through 10" } ] } ] }, { "description": "Calcium Gluconate Inj 10% - 75834017119", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "75834017119", "type": "NDC" }, { "code": "J0612", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "median_amount": 80.53, "10th_percentile": 80.53, "90th_percentile": 80.53, "count": "1 through 10" } ] } ] }, { "description": "Carbachol Intraocular Inj 0.01%", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00065002315", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Calcium Gluconate-Nacl Iv Soln 1 Gm/50Ml-0.675% (20 Mg/Ml)", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "44567062001", "type": "NDC" }, { "code": "J0612", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "median_amount": 80.53, "10th_percentile": 80.53, "90th_percentile": 80.53, "count": "1 through 10" } ] } ] }, { "description": "Carboplatin Iv Soln 150 Mg/15Ml - 61703033956", "drug_information": { "unit": 60.0, "type": "ML" }, "code_information": [ { "code": "61703033956", "type": "NDC" }, { "code": "J9045", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 143.14, "10th_percentile": 100.59, "90th_percentile": 211.26, "count": "1 through 10" } ] } ] }, { "description": "Carboplatin Iv Soln 150 Mg/15Ml - 61703033922", "drug_information": { "unit": 15.0, "type": "ML" }, "code_information": [ { "code": "61703033922", "type": "NDC" }, { "code": "J9045", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 143.14, "10th_percentile": 100.59, "90th_percentile": 211.26, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14876.0, "minimum": 8747.7, "maximum": 27522.3205, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13449.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13718.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 14121.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19340.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 14876.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 23803.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13240.47, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 14281.85, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13449.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14876.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14876.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18747.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 27522.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 13449.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 13449.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 14876.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13449.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13449.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14876.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 15620.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13718.18, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Iv Syringe In Sw", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "99999070125", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 276.0, "10th_percentile": 276.0, "90th_percentile": 276.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 326.6, "10th_percentile": 326.6, "90th_percentile": 326.6, "count": "15" } ] } ] }, { "description": "Carboplatin Iv Soln 50 Mg/5Ml", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00703424401", "type": "NDC" }, { "code": "J9045", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 143.14, "10th_percentile": 100.59, "90th_percentile": 211.26, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55451.0, "minimum": 26833.6, "maximum": 105505.014, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 50009.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51009.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 52509.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 72087.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 55451.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 88722.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 49351.87, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 53233.48, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 50009.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55451.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55451.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42494.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 102585.35, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 50009.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 50009.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 55451.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 50009.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 50009.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 55451.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 58224.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 51009.59, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 1 Gm - 00781320895", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00781320895", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 276.0, "10th_percentile": 276.0, "90th_percentile": 276.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 326.6, "10th_percentile": 326.6, "90th_percentile": 326.6, "count": "15" } ] } ] }, { "description": "Carboplatin Iv Soln 600 Mg/60Ml", "drug_information": { "unit": 60.0, "type": "ML" }, "code_information": [ { "code": "63323017260", "type": "NDC" }, { "code": "J9045", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 143.14, "10th_percentile": 100.59, "90th_percentile": 211.26, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30233.0, "minimum": 24669.6, "maximum": 66641.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27286.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27832.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 28651.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 39304.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 30233.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 48374.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 26908.16, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 29024.53, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27286.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30233.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30233.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66641.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 55932.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 27286.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 27286.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 30233.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 27286.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27286.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 30233.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 31745.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27832.54, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium In Dextrose Inj 20 Mg/Ml", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00338500241", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 276.0, "10th_percentile": 276.0, "90th_percentile": 276.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 326.6, "10th_percentile": 326.6, "90th_percentile": 326.6, "count": "15" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6252.0, "minimum": 2915.9, "maximum": 24385.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5678.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5791.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 5961.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 8128.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 6252.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 10003.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 5564.72, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 6002.39, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5678.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6252.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6252.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8819.25 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 11567.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 5678.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 5678.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 6252.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5678.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5678.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6252.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 6565.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5791.63, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 250 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00409733701", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 276.0, "10th_percentile": 276.0, "90th_percentile": 276.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 326.6, "10th_percentile": 326.6, "90th_percentile": 326.6, "count": "15" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 60659.0, "minimum": 22505.6, "maximum": 150206.1532, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 54701.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55795.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 57437.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 78857.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 60659.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 97054.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 53986.82, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 58232.98, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 54701.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 60659.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 60659.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59239.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 112219.8, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 54701.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 54701.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 60659.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 54701.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 54701.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 60659.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 63692.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 55795.94, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22929.0, "minimum": 7540.0, "maximum": 42418.7055, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20704.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21118.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 21739.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29807.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 22929.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 20406.84, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 22011.87, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20704.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22929.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22929.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16418.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 42418.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 20704.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 20704.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 22929.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 20704.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20704.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22929.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 24075.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21118.69, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14749.0, "minimum": 4486.0, "maximum": 37297.3988, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13334.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13601.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 14001.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19174.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 14749.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 23599.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13127.18, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 14159.65, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13334.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14749.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14749.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26003.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 27286.83, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 13334.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 13334.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 14749.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13334.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13334.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14749.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 15487.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13601.19, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium In Dextrose Inj 40 Mg/Ml", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00338500341", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 276.0, "10th_percentile": 276.0, "90th_percentile": 276.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 326.6, "10th_percentile": 326.6, "90th_percentile": 326.6, "count": "15" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 90031.0, "minimum": 46309.6, "maximum": 166558.6635, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 81168.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 82791.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 85226.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 117041.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 90031.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 144050.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 80128.22, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 86430.44, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 81168.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 90031.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 90031.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 129457.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 166558.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 81168.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 81168.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 90031.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 81168.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 81168.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 90031.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 94533.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 82791.56, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9217.0, "minimum": 7540.0, "maximum": 17052.671, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8349.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8516.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8767.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11982.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 9217.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 8203.72, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8848.95, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8349.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9217.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9217.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8594.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 17052.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 8349.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 8349.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 9217.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8349.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8349.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9217.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 9678.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8516.86, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5630.0, "minimum": 4037.4, "maximum": 16447.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5117.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5220.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 5373.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 7319.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 5630.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 9009.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 5011.32, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 5405.47, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5117.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5630.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5630.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5086.95 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 10416.8, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 5117.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 5117.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 5630.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5117.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5117.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5630.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 5912.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5220.16, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8421.0, "minimum": 6442.72, "maximum": 33628.6524, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7632.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7785.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8014.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10948.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8421.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 13475.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7495.47, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8085.0, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7632.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6442.72 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 15580.48, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7632.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7632.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8421.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7632.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7632.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8421.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8842.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7785.48, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49281.0, "minimum": 24236.8, "maximum": 115138.3288, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45338.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 46672.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 64065.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 49281.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 78850.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 43860.34, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 47310.03, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 44449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49281.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49281.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59120.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 91170.37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 44449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 44449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 49281.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 44449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 44449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 49281.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 51745.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45338.59, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8809.0, "minimum": 4934.6, "maximum": 16297.094, "payers_information": [ { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8809.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9996.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 16297.09, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7981.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7981.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8809.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7981.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7981.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8809.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 9249.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8141.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7981.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8141.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8380.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11452.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8809.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 14094.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7840.22, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8456.87, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7981.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8809.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15551.0, "minimum": 7540.0, "maximum": 28770.8855, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14057.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14338.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 14760.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20217.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 15551.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13841.13, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 14929.76, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14057.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15551.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15551.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 28770.89, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 14057.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 14057.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 15551.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14057.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14057.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15551.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 16329.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14338.45, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 70759.0, "minimum": 36788.0, "maximum": 130905.926, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 63803.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 65079.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 66993.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 91987.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 70759.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 113215.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 62976.36, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 67929.56, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 63803.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 70759.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 70759.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 85800.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 130905.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 63803.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 63803.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 70759.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 63803.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 63803.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 70759.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 74297.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 65079.26, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Change Of Bladder Tube", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7687.5, "discounted_cash": 279.0, "minimum": 175.72, "maximum": 7303.125, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 403.81 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 262.83 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 285.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 293.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 391.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 279.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 297.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 248.5, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 175.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 279.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 279.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 356.78 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 186.45 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 279.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3774.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 279.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65742.0, "minimum": 35922.4, "maximum": 137214.7704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 59282.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 60467.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 62246.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 85465.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 65742.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 105188.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 58510.93, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 63112.92, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 59282.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65742.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65742.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 73450.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 121623.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 59282.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 59282.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 65742.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 59282.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 59282.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 65742.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 69029.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 60467.95, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [ { "code": "837", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44441.0, "minimum": 23327.2, "maximum": 82216.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40088.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40890.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 42093.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 57774.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 44441.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 71106.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 39553.02, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 42663.94, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 40088.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44441.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44441.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57387.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 82216.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 40088.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 40088.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 44441.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 40088.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40088.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 44441.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 46663.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40890.58, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Care Of Miscarriage", "code_information": [ { "code": "59820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6692.5, "discounted_cash": 3621.0, "minimum": 1251.0, "maximum": 25455.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 3637.57 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2367.55 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3694.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3802.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5070.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3860.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3219.76, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3085.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1859.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3694.22, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24187.0, "minimum": 13458.0, "maximum": 44746.431, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21838.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22275.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 22930.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31443.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 24187.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 38699.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 21526.66, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 23219.77, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21838.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24187.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24187.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17588.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 44746.43, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 21838.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 21838.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 24187.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 21838.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21838.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 24187.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 25396.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22275.17, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18963.0, "minimum": 10387.2, "maximum": 74306.9632, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17131.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17474.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 17988.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24653.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 18963.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 30342.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16877.85, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 18205.32, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17131.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18963.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18963.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22005.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 35083.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 17131.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 17131.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 18963.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17131.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17131.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18963.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 19912.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17474.44, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7040.0, "minimum": 3813.1, "maximum": 15581.8924, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6387.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6515.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 6707.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9152.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 7040.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 11264.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6265.63, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 6758.43, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6387.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7040.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7040.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7392.42 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 13024.06, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6387.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6387.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 7040.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6387.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6387.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7040.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 7392.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6515.44, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35892.0, "minimum": 20341.6, "maximum": 88422.2708, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32385.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33033.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 34004.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 46659.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 35892.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 57427.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 31944.1, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 34456.56, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32385.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35892.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35892.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48686.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 66400.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 32385.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 32385.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 35892.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 32385.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32385.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 35892.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 37686.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33033.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 60659.0, "minimum": 9954.4, "maximum": 175403.0852, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 54701.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55795.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 57437.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 78857.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 60659.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 97054.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 53986.82, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 58232.98, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 54701.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 60659.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 60659.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 74484.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 112219.8, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 54701.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 54701.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 60659.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 54701.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 54701.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 60659.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 63692.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 55795.94, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 395888.0, "minimum": 27588.9, "maximum": 986467.8832, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 356764.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 363899.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 374602.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 514655.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 395888.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 633422.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 352341.09, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 380053.32, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 356764.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 395888.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 395888.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 409690.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 732394.41, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 356764.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 356764.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 395888.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 356764.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 356764.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 395888.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 415683.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 363899.28, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For Inj 500 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00781345070", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 19.69, "10th_percentile": 19.69, "90th_percentile": 19.69, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 11.65, "10th_percentile": 5.83, "90th_percentile": 17.48, "count": "1 through 10" } ] } ] }, { "description": "Cefiderocol Sulfate Tosylate For Iv Soln 1 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "59630026601", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30696.0, "minimum": 24669.6, "maximum": 75460.5852, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27703.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28257.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 29088.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 39905.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 30696.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 49114.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 27319.74, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 29468.49, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27703.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30696.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30696.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34259.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 56788.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 27703.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 27703.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 30696.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 27703.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27703.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 30696.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 32231.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28257.57, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22337.0, "minimum": 8223.2, "maximum": 54608.582, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20575.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20171.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20575.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 21180.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29038.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 22337.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 35739.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 19880.34, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 21443.96, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20171.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22337.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22337.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31007.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 41324.3, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 20171.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 20171.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 22337.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 20171.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20171.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22337.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 23454.33, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Cefazolin In D5W Inj 1 Gm/50Ml", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00338350341", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 19.69, "10th_percentile": 19.69, "90th_percentile": 19.69, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 11.65, "10th_percentile": 5.83, "90th_percentile": 17.48, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19372.0, "minimum": 17241.347, "maximum": 47211.6948, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17499.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17849.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 18374.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25183.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 19372.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 30995.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17241.35, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 18597.41, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17499.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19372.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19372.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25324.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 35838.76, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 17499.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 17499.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 19372.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17499.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17499.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19372.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 20340.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17849.8, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Iv Syringe In Sw", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "09999080501", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 19.69, "10th_percentile": 19.69, "90th_percentile": 19.69, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 11.65, "10th_percentile": 5.83, "90th_percentile": 17.48, "count": "1 through 10" } ] } ] }, { "description": "CHROMOTUBATION OF OVIDUCT,INC MATERIALS", "code_information": [ { "code": "58350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8758.92, "discounted_cash": 5596.0, "minimum": 1324.0, "maximum": 8320.974, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7153.66 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 4656.03 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5708.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 5876.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7835.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5966.26, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3166.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5854.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5708.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10246.0, "minimum": 4710.3, "maximum": 61820.4328, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9276.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9462.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 9740.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13319.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 10246.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 16393.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 9118.97, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 9836.19, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9276.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10246.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10246.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13671.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 18955.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 9276.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 9276.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 10246.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9276.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9276.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10246.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 10758.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9462.02, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For Inj 2 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505623100", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 19.69, "10th_percentile": 19.69, "90th_percentile": 19.69, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 11.65, "10th_percentile": 5.83, "90th_percentile": 17.48, "count": "1 through 10" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8166.0, "minimum": 6056.1, "maximum": 18409.9796, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7550.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7772.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10616.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8166.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 13066.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7268.09, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7839.73, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8166.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8166.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9061.76 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 15107.82, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7402.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8166.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8166.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8574.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7550.65, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 1 Gm - 44567070125", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567070125", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 276.0, "10th_percentile": 276.0, "90th_percentile": 276.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 326.6, "10th_percentile": 326.6, "90th_percentile": 326.6, "count": "15" } ] } ] }, { "description": "Cisplatin Inj 100 Mg/100 Ml (1 Mg/Ml)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00703574811", "type": "NDC" }, { "code": "J9060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 213.0, "10th_percentile": 161.88, "90th_percentile": 255.6, "count": "1 through 10" } ] } ] }, { "description": "Cefazolin Sodium For Iv Soln 1 Gm And Dextrose", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00338350341", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 19.69, "10th_percentile": 19.69, "90th_percentile": 19.69, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 11.65, "10th_percentile": 5.83, "90th_percentile": 17.48, "count": "1 through 10" } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13462.0, "minimum": 10317.8, "maximum": 24904.9035, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12174.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12417.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 12783.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17500.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 13462.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 21539.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 11981.28, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 12923.63, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12174.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13462.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13462.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14315.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 24904.9, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 12174.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 12174.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 13462.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12174.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12174.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13462.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 14135.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12417.89, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cisplatin Inj 100 Mg/100Ml (1 Mg/Ml)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00703574811", "type": "NDC" }, { "code": "J9060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 213.0, "10th_percentile": 161.88, "90th_percentile": 255.6, "count": "1 through 10" } ] } ] }, { "description": "Cisatracurium Besylate (Pf) Iv Soln 10 Mg/5Ml - 63323041710", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323041710", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Clindamycin Phosphate In D5W Iv Soln 900 Mg/50Ml - 00781329009", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00781329009", "type": "NDC" }, { "code": "J0736", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4.83, "10th_percentile": 4.83, "90th_percentile": 4.83, "count": "1 through 10" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44665.0, "minimum": 30728.8, "maximum": 110306.8228, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40290.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41095.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 42304.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 58064.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 44665.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 71464.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 39751.89, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 42878.44, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 40290.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44665.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44665.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49687.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 82630.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 40290.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 40290.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 44665.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 40290.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40290.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 44665.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 46898.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41095.9, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14414.0, "minimum": 8074.8, "maximum": 48582.3348, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13032.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13293.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 13684.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18738.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 14414.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 23063.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 12828.89, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 13837.9, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13032.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14414.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14414.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14111.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 26666.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 13032.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 13032.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 14414.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13032.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13032.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14414.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 15135.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13293.15, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Clindamycin Phosphate In D5W Iv Soln 600 Mg/50Ml - 00781328991", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00781328991", "type": "NDC" }, { "code": "J0736", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4.83, "10th_percentile": 4.83, "90th_percentile": 4.83, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9226.0, "minimum": 7540.0, "maximum": 17069.617, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8358.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8525.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8776.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11994.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 9226.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 8211.87, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8857.75, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8358.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9226.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9226.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11206.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 17069.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 8358.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 8358.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 9226.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8358.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8358.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9226.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 9688.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8525.27, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10368.0, "minimum": 7177.6, "maximum": 24751.474, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9387.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9574.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 9856.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13479.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 10368.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 16589.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 9228.18, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 9953.99, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9387.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10368.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10368.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11324.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 19182.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 9387.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 9387.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 10368.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9387.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9387.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10368.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 10887.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9574.8, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Clindamycin Phosphate In D5W Iv Soln 600 Mg/50Ml - 00781922109", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00781922109", "type": "NDC" }, { "code": "J0736", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4.83, "10th_percentile": 4.83, "90th_percentile": 4.83, "count": "1 through 10" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17212.0, "minimum": 9869.2, "maximum": 31842.3295, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15553.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15864.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 16330.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22375.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 17212.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 27539.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15318.74, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 16523.59, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15553.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17212.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17212.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16083.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 31842.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 15553.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 15553.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 17212.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15553.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15553.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17212.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 18072.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15864.37, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Clindamycin Phosphate In D5W Iv Soln 900 Mg/50Ml - 00009338202", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00009338202", "type": "NDC" }, { "code": "J0736", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4.83, "10th_percentile": 4.83, "90th_percentile": 4.83, "count": "1 through 10" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19561.0, "minimum": 11663.6, "maximum": 36189.441, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17670.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18024.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 18554.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25430.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 19561.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 31298.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17410.06, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 18779.39, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17670.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19561.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19561.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17538.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 36189.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 17670.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 17670.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 19561.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17670.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17670.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19561.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 20539.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18024.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 100025.0, "minimum": 28037.5, "maximum": 227457.708, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 90172.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 91976.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 94681.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 130032.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 100025.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 160040.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 89022.41, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 96024.17, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 90172.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 100025.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 100025.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 136391.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 185046.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 90172.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 90172.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 100025.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 90172.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 90172.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 100025.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 105026.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 91976.36, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Colonoscopy Thru Stoma Spx", "code_information": [ { "code": "44388", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1040.0, "minimum": 519.96, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1471.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 957.56 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1061.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1092.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1456.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1109.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 924.97, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 844.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1061.27, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13669.0, "minimum": 8747.7, "maximum": 73898.0556, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12360.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13669.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13669.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11600.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 25287.78, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 12360.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 12360.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 13669.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12360.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12360.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13669.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 14352.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12608.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12360.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12608.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 12978.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17769.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 13669.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 21870.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 12165.47, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 13122.31, "additional_payer_notes": "96.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10507.0, "minimum": 5607.5, "maximum": 23369.412, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9511.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9701.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 9987.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13659.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 10507.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 16811.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 9351.25, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 10086.74, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9511.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10507.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10507.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17158.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 19437.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 9511.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 9511.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 10507.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9511.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9511.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10507.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 11032.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9701.89, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 2 Gm - 00781320995", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00781320995", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 276.0, "10th_percentile": 276.0, "90th_percentile": 276.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 326.6, "10th_percentile": 326.6, "90th_percentile": 326.6, "count": "15" } ] } ] }, { "description": "Colonoscopy W/Snare", "code_information": [ { "code": "44394", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1338.0, "minimum": 844.72, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1471.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 957.56 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1405.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1874.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1427.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 844.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8225.0, "minimum": 6056.1, "maximum": 61895.818, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7455.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7604.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7828.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10692.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8225.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 13160.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7320.25, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7896.0, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7455.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8225.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8225.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8220.32 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 15216.25, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7455.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7455.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8225.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7455.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7455.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8225.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8636.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7604.52, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Conization Of Cervix - 57520 - OR36057520", "code_information": [ { "code": "57520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 3621.0, "minimum": 1045.331, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 3637.57 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2367.55 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3694.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3802.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5070.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3860.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3219.76, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1859.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3694.22, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 2 Gm - 60505075304", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505075304", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 276.0, "10th_percentile": 276.0, "90th_percentile": 276.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 326.6, "10th_percentile": 326.6, "90th_percentile": 326.6, "count": "15" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18415.0, "minimum": 11215.0, "maximum": 44824.4968, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16637.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16970.25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 17469.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23939.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 18415.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 29464.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16389.66, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 17678.74, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16637.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18415.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18415.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16885.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 34068.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 16637.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 16637.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 18415.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16637.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16637.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18415.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 19336.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16970.25, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8104.0, "minimum": 5383.2, "maximum": 44109.4796, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7346.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7493.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7713.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10535.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8104.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 12966.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7212.67, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7779.96, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7346.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8104.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8104.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9114.77 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 14992.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7346.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7346.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8104.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7346.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7346.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8104.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8509.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7493.43, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 500 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00409733801", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 276.0, "10th_percentile": 276.0, "90th_percentile": 276.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 326.6, "10th_percentile": 326.6, "90th_percentile": 326.6, "count": "15" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7778.0, "minimum": 5383.2, "maximum": 18288.9064, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7052.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7193.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7405.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10111.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 7778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 12444.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6922.52, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7466.99, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7052.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6687.47 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 14389.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7052.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7052.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 7778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7052.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7052.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8167.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7193.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 70456.0, "minimum": 48906.4, "maximum": 130345.1725, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 63530.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 64800.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 66706.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 91593.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 70456.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 112730.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 62706.6, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 67638.58, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 63530.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 70456.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 70456.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 88514.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 130345.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 63530.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 63530.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 70456.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 63530.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 63530.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 70456.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 73979.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 64800.7, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 77642.0, "minimum": 46742.4, "maximum": 143638.9395, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 70004.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 71405.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 73505.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 100935.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 77642.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 124228.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 69101.98, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 74536.96, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 70004.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 77642.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 77642.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66821.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 143638.94, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 70004.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 70004.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 77642.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 70004.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 70004.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 77642.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 81524.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 71405.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55964.0, "minimum": 32892.8, "maximum": 174646.9488, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 50471.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51480.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 52995.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 72753.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 55964.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 89542.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 49808.27, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 53725.78, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 50471.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55964.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55964.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 76481.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 103534.05, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 50471.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 50471.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 55964.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 50471.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 50471.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 55964.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 58762.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 51480.93, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27425.0, "minimum": 10820.0, "maximum": 67300.7084, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24756.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25251.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 25993.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 35652.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 27425.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 43880.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 24408.53, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 26328.31, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24756.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27425.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27425.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31101.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 50736.84, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 24756.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 24756.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 27425.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 24756.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24756.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 27425.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 28796.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25251.22, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54187.0, "minimum": 35056.8, "maximum": 100247.467, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48870.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49848.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 51314.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 70444.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 54187.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 86700.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 48227.16, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 52020.31, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 48870.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54187.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54187.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 68210.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 100247.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 48870.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 48870.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 54187.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 48870.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48870.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 54187.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 56897.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49848.11, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33070.0, "minimum": 29433.0565, "maximum": 81384.0344, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29843.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30439.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 31335.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 42992.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 33070.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 52913.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 29433.06, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 31748.02, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29843.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33070.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33070.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43867.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 61181.07, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 29843.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 29843.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 33070.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 29843.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29843.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 33070.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 34724.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30439.86, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Corrj Halux Rigdus W/Implt", "code_information": [ { "code": "28291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7512.5, "discounted_cash": 8118.0, "minimum": 1423.0, "maximum": 7512.5, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6315.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7512.5 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 6642.21 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 7217.29, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22802.0, "minimum": 6924.8, "maximum": 55769.0572, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21002.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 21620.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29643.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 22802.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 36484.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 20294.37, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 21890.55, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22802.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22802.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26573.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 42184.92, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 20590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 20590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 22802.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 20590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22802.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 23942.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21002.62, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Corrj Halux Rigdus W/O Implt", "code_information": [ { "code": "28289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9171.31, "discounted_cash": 3660.0, "minimum": 1045.331, "maximum": 8712.7445, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4682.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 3047.36 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3843.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5125.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3902.4, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3254.44, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2031.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19700.0, "minimum": 17533.1157, "maximum": 48029.51, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17795.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18151.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 18684.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25610.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 19700.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 31520.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17533.12, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 18912.12, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17795.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19700.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19700.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26687.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 36445.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 17795.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 17795.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 19700.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17795.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17795.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19700.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 20685.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18151.1, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 52921.0, "minimum": 31594.4, "maximum": 130902.9732, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 47729.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 48684.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 50115.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 68797.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 52921.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 84674.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 47100.0, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 50804.5, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 47729.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52921.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52921.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71392.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 97904.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 47729.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 47729.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 52921.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 47729.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 47729.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 52921.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 55567.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 48684.09, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10154.0, "minimum": 7540.0, "maximum": 18785.751, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9377.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 9653.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13200.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 10154.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 9037.47, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 9748.28, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10154.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10154.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10358.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 18785.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 9193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 9193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 10154.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10154.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 10662.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9377.86, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15652.0, "minimum": 12118.4, "maximum": 37932.462, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14148.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14431.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 14855.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20348.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 15652.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 25044.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13930.78, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 15026.46, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14148.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15652.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15652.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20814.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 28957.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 14148.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 14148.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 15652.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14148.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14148.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15652.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 16435.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14431.06, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10673.0, "minimum": 7540.0, "maximum": 19746.308, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9661.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9855.07, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 10144.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13875.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 10673.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 9499.58, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 10246.73, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9661.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10673.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10673.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15333.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 19746.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 9661.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 9661.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 10673.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9661.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9661.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10673.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 11207.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9855.07, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28918.0, "minimum": 12984.0, "maximum": 71026.5648, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26101.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26623.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 27407.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 37594.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 28918.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 46270.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 25737.81, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 27762.13, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26101.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28918.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28918.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32035.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 53499.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 26101.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 26101.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 28918.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 26101.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26101.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 28918.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 30364.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26623.94, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12426.0, "minimum": 8747.7, "maximum": 22988.8585, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11241.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11465.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 11803.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16154.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 12426.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 19882.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 11059.5, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 11929.35, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11241.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12426.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12426.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10193.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 22988.86, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 11241.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 11241.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 12426.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11241.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11241.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12426.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 13047.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11465.92, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cyanocobalamin Inj 1000 Mcg/Ml", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00517003125", "type": "NDC" }, { "code": "J3420", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 15.8, "10th_percentile": 13.72, "90th_percentile": 31.03, "count": "27" } ] } ] }, { "description": "Circum 28 Days Or Older", "code_information": [ { "code": "54161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7829.17, "discounted_cash": 2338.0, "minimum": 1045.331, "maximum": 8516.7025, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2944.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1916.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2455.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3274.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2493.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2079.17, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2146.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18470.0, "minimum": 16438.5581, "maximum": 44961.5608, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16687.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17020.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 17521.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24011.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 18470.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 29552.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16438.56, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 17731.48, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16687.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18470.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18470.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22344.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 34170.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 16687.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 16687.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 18470.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16687.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16687.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18470.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 19393.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17020.74, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12930.0, "minimum": 11508.5722, "maximum": 31143.2252, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11929.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 12280.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16810.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 12930.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 20689.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 11508.57, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 12413.74, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12930.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12930.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25626.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 23922.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 11695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 11695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 12930.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12930.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 13577.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11929.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6971.0, "minimum": 4710.3, "maximum": 16276.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6452.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 6642.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9062.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 6971.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 11154.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6204.5, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 6692.5, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6971.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6971.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7498.46 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 12897.0, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 6971.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6971.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 7319.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6452.32, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cysto W/Urtrl Cathj", "code_information": [ { "code": "52005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6723.21, "discounted_cash": 2338.0, "minimum": 1045.331, "maximum": 6387.0495, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2944.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1916.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2455.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3274.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2493.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2079.17, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1766.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10590.0, "minimum": 7626.2, "maximum": 30026.1536, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 9425.41, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 10166.74, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9586.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10590.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10590.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10185.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 19592.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 9586.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 9586.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 10590.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9586.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9586.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10590.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 11119.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9778.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9586.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9778.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 10066.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13767.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 10590.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 16944.56, "additional_payer_notes": "160.00% of Medicare Rates" } ] } ] }, { "description": "Cysto impl 4 or more", "code_information": [ { "code": "C9740", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6906.25, "discounted_cash": 10591.0, "minimum": 1423.0, "maximum": 6906.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6906.25 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6678.37 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4994.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2819.05 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6315.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6906.25, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cisatracurium Besylate (Pf) Iv Soln 10 Mg/5Ml (2 Mg/Ml)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00074437805", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Cystoscopy And Treatment - 52332 - OR36052332", "code_information": [ { "code": "52332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7219.75, "discounted_cash": 3943.0, "minimum": 1045.331, "maximum": 6858.7625, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4384.78 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2853.88 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4022.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4141.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5521.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4204.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3506.07, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2404.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4022.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6325.0, "minimum": 4710.3, "maximum": 14357.454, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5744.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5858.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 6031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 8223.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 6325.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 10121.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 5629.92, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 6072.72, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5744.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5647.52 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 11702.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 5744.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 5744.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 6325.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5744.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5744.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6325.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 6642.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5858.96, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52234 - OR36052234", "code_information": [ { "code": "52234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11434.3, "discounted_cash": 3943.0, "minimum": 1045.331, "maximum": 10862.585, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4384.78 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2853.88 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4022.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4141.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5521.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4204.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3506.07, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2404.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4022.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cisplatin Inj 50 Mg/50Ml (1 Mg/Ml)", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00703574711", "type": "NDC" }, { "code": "J9060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 213.0, "10th_percentile": 161.88, "90th_percentile": 255.6, "count": "1 through 10" } ] } ] }, { "description": "Cystoscopy W/Biopsy(S)", "code_information": [ { "code": "52204", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7916.48, "discounted_cash": 2338.0, "minimum": 519.96, "maximum": 7520.656, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2944.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1916.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2455.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3274.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2493.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2079.17, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1766.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20710.0, "minimum": 12112.2, "maximum": 38313.8515, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18705.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19079.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 19640.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26923.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 20710.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 24300.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 33136.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 18432.07, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 19881.78, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18705.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20710.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20710.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22991.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 38313.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 18705.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 18705.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 20710.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 18705.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18705.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20710.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 21745.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19079.41, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52235 - OR36052235", "code_information": [ { "code": "52235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10313.7, "discounted_cash": 3943.0, "minimum": 1251.0, "maximum": 9798.015, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4384.78 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2853.88 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4022.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4141.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5521.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4204.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3506.07, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2404.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4022.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Clindamycin Phosphate Inj 900 Mg/6Ml", "drug_information": { "unit": 6.0, "type": "ML" }, "code_information": [ { "code": "00009090211", "type": "NDC" }, { "code": "J0736", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4.83, "10th_percentile": 4.83, "90th_percentile": 4.83, "count": "1 through 10" } ] } ] }, { "description": "CYSTOURETHRO WADDL IMPLANT", "code_information": [ { "code": "52442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2375.0, "minimum": 290.0, "maximum": 2375.0, "payers_information": [ { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1973.56 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1284.52 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2375.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10118.0, "minimum": 7401.9, "maximum": 24127.8328, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9161.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9345.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 9619.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13154.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 10118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 16190.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 9005.69, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 9714.0, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9161.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11384.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 18719.69, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 9161.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 9161.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 10118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9161.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9161.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 10624.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9345.04, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOSCOPY REMOVAL OF CLOTS", "code_information": [ { "code": "52001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3251.41, "discounted_cash": 3943.0, "minimum": 975.423, "maximum": 3251.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2944.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1916.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1766.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3251.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3251.41, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOURETHRO WIMPLANT", "code_information": [ { "code": "52441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4750.0, "minimum": 290.0, "maximum": 4512.5, "payers_information": [ { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2567.74 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1671.24 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3774.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 } ] } ] }, { "description": "Cisatracurium Besylate (Pf) Iv Soln 10 Mg/5Ml - 00074437805", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00074437805", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Colonoscopy W/Lesion Removal - 45384 - OR36045384", "code_information": [ { "code": "45384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6668.06, "discounted_cash": 1338.0, "minimum": 844.72, "maximum": 6334.657, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1471.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 957.56 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1405.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1874.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1427.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 844.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cisatracurium Besylate Iv Soln 20 Mg/10Ml (2 Mg/Ml)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00074438010", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9625.0, "minimum": 6504.7, "maximum": 17806.546, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8717.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8891.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 9152.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12512.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 9625.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 15400.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 8566.39, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 9240.15, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8717.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9625.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9625.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9315.54 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 17806.55, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 8717.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 8717.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 9625.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8717.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8717.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9625.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 10106.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8891.39, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dantrolene Sodium For Iv Soln 20 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "42023012306", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6750.0, "minimum": 4710.3, "maximum": 39963.2936, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6126.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6249.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 6433.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 8775.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 6750.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 10801.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6008.08, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 6480.62, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6126.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6750.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6750.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6779.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 12488.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6126.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6126.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 6750.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6126.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6126.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6750.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 7088.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6249.48, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CCMCC", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5383.2, "maximum": 10800.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9888.53 } ] } ] }, { "description": "Colonoscopy And Biopsy", "code_information": [ { "code": "45380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6808.42, "discounted_cash": 1338.0, "minimum": 519.96, "maximum": 6467.999, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 2625.0, "10th_percentile": 1312.5, "90th_percentile": 3937.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1471.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 957.56 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1405.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1874.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1427.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 844.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 519.96, "10th_percentile": 519.96, "90th_percentile": 519.96, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7985.0, "minimum": 4486.0, "maximum": 18190.6772, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7239.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7384.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7601.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10380.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 7985.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 12776.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7106.71, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7665.67, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7239.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7985.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7985.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14056.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 14772.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7239.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7239.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 7985.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7239.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7239.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7985.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8384.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7384.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Colonoscopy W/Ablation", "code_information": [ { "code": "45388", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1338.0, "minimum": 957.56, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1471.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 957.56 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1405.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1874.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1427.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1000.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Conization Of Cervix - 57522 - OR36057522", "code_information": [ { "code": "57522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6615.28, "discounted_cash": 3621.0, "minimum": 519.96, "maximum": 6284.516, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 3637.57 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2367.55 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3694.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3802.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5070.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3860.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3219.76, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1859.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3694.22, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Destruct B9 Lesion 1-14", "code_information": [ { "code": "17110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 224.0, "minimum": 59.045, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 230.3 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 149.89 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 235.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 314.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.29, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 199.55, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 135.74 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 59.05 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3774.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Colonoscopy W/Band Ligation", "code_information": [ { "code": "45398", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1338.0, "minimum": 957.56, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1471.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 957.56 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1405.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1874.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1427.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1000.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt Musc&/Fsca 1St 20/<", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7125.0, "discounted_cash": 826.0, "minimum": 112.042, "maximum": 6768.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 837.81 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 545.31 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 843.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 868.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1157.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 881.46, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 735.11, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 263.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 112.04 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3774.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 843.43, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11008.0, "minimum": 7626.2, "maximum": 20366.3725, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9963.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10163.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 10462.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14311.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 11008.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 17614.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 9797.88, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 10568.5, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9963.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11008.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11008.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14175.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 20366.37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 9963.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 9963.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 11008.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9963.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9963.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11008.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 11559.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10163.11, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Elixir 0.5 Mg/5Ml", "drug_information": { "unit": 237.0, "type": "ML" }, "code_information": [ { "code": "00603114756", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4.28, "10th_percentile": 4.28, "90th_percentile": 4.28, "count": "1 through 10" } ] } ] }, { "description": "Colonoscopy W/Lesion Removal - 45385 - OR36045385", "code_information": [ { "code": "45385", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6591.73, "discounted_cash": 1338.0, "minimum": 844.72, "maximum": 6262.1435, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 3937.5, "10th_percentile": 1312.5, "90th_percentile": 3937.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1471.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 957.56 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1405.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1874.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 4593.75, "10th_percentile": 4593.75, "90th_percentile": 4593.75, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1427.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 844.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23172.0, "minimum": 13009.4, "maximum": 42869.347, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20924.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21342.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 21970.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 30124.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 23172.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 37076.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 20623.63, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 22245.72, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20924.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23172.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23172.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27339.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 42869.35, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 20924.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 20924.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 23172.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 20924.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20924.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 23172.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 24331.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21342.58, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Sod Phosphate Preservative Free Inj 10 Mg/Ml", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "55150030401", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 10.32, "10th_percentile": 10.32, "90th_percentile": 41.47, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 6.11, "10th_percentile": 3.32, "90th_percentile": 22.33, "count": "61" } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12825.0, "minimum": 8074.8, "maximum": 40118.6328, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11600.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11832.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 12180.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16673.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 12825.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 20521.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 11414.85, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 12312.64, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11600.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12825.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12825.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17662.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 23727.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 11600.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 11600.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 12825.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11600.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11600.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12825.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 13466.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11832.92, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12311.0, "minimum": 8523.4, "maximum": 29596.6864, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12311.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12311.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18225.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 22775.41, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 11137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 11137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 12311.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12311.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 12926.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11359.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11359.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 11694.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16004.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 12311.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 19697.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 10956.82, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 11818.59, "additional_payer_notes": "96.00% of Medicare Rates" } ] } ] }, { "description": "Cor Hlx Vlgs Double Osteot", "code_information": [ { "code": "28299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10362.5, "discounted_cash": 8118.0, "minimum": 1324.0, "maximum": 10362.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4682.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 3047.36 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8280.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 8524.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10362.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8654.26, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 7217.29, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3085.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2919.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4632.01 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2272.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5854.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8280.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Tab 4 Mg", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00054817525", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4.28, "10th_percentile": 4.28, "90th_percentile": 4.28, "count": "1 through 10" } ] } ] }, { "description": "Cor Hlx Vlgs Dstl Mtar Osteo", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8677.5, "discounted_cash": 3660.0, "minimum": 1324.0, "maximum": 8243.625, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4682.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 3047.36 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3843.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5125.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3902.4, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3254.44, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2919.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5854.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cor hlx vlgs prx phlx osteot", "code_information": [ { "code": "28298", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3035.73, "discounted_cash": 8118.0, "minimum": 910.719, "maximum": 3035.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 3035.73 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 3035.73 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2919.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3035.73 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3035.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3035.73, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dexmedetomidine Hcl Iv Soln 200 Mcg/2Ml - 00409163802", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409163802", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Cor Hlx Vlgs Jt Arthrd", "code_information": [ { "code": "28297", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10932.9, "discounted_cash": 14364.0, "minimum": 1324.0, "maximum": 10932.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10932.9 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 8986.01 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2919.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5854.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10932.9, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6934.0, "minimum": 4486.0, "maximum": 43727.9848, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6292.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6418.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 6607.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9015.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 6934.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 11095.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6171.9, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 6657.33, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6292.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6934.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6934.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6573.56 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 12829.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6292.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6292.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 6934.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6292.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6292.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6934.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 7281.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6418.66, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 50470.0, "minimum": 35056.8, "maximum": 134062.2984, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45521.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46431.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 47797.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 65612.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 50470.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 80753.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 44919.04, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 48452.0, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45521.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 50470.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 50470.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 72599.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 93371.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 45521.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 45521.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 50470.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 45521.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45521.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 50470.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 52994.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 46431.93, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose 5% W/ Sodium Chloride 0.45%", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00264761200", "type": "NDC" }, { "code": "J7060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 17.7, "10th_percentile": 17.7, "90th_percentile": 17.7, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 10.47, "10th_percentile": 8.57, "90th_percentile": 17.75, "count": "94" } ] } ] }, { "description": "Cor Hlx Vlgs Prx Mtar Osteot", "code_information": [ { "code": "28295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8462.5, "discounted_cash": 3660.0, "minimum": 1324.0, "maximum": 8039.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2142.96 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1394.77 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3843.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5125.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3902.4, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3254.44, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5854.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9062.0, "minimum": 4508.0, "maximum": 18000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8210.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8374.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8620.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11781.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 9062.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 14500.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 8065.98, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8700.38, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8210.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9062.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9062.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5174.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 16766.37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 8210.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 8210.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 9062.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8210.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8210.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9062.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 9516.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8374.62, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29301.0, "minimum": 9954.4, "maximum": 113932.1656, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26446.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26975.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 27769.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 38092.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 29301.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 46882.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 26078.49, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 28129.6, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26446.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29301.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29301.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44968.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 54208.09, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 26446.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 26446.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 29301.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 26446.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26446.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 29301.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 30766.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26975.74, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose Inj 10%", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00264752000", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Cor Hlx Vlgs Rsc Prx Phlx Bs", "code_information": [ { "code": "28292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7987.5, "discounted_cash": 3660.0, "minimum": 1045.331, "maximum": 7588.125, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4682.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 3047.36 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3843.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5125.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3902.4, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3254.44, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2919.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5854.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29845.0, "minimum": 11685.6, "maximum": 55835.3048, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26936.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27475.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 28283.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 38799.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 29845.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 47752.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 26562.6, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 28651.8, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26936.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29845.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29845.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35833.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 55214.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 26936.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 26936.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 29845.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 26936.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26936.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 29845.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 31337.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27475.64, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose Inj 5% - 00264151031 - 25800001", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00264151031", "type": "NDC" }, { "code": "J7070", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 8.63, "10th_percentile": 8.63, "90th_percentile": 10.47, "count": "1 through 10" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38805.0, "minimum": 25102.4, "maximum": 112431.3148, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35010.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35710.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 36760.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 50446.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 38805.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 62088.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 34536.65, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 37253.01, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35010.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38805.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38805.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55128.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 71789.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 35010.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 35010.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 38805.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 35010.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35010.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 38805.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 40745.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35710.2, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 10 Mg/Ml - 00641036725", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641036725", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 10.32, "10th_percentile": 10.32, "90th_percentile": 41.47, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 6.11, "10th_percentile": 3.32, "90th_percentile": 22.33, "count": "61" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15137.0, "minimum": 8747.7, "maximum": 36648.6292, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13684.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13958.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 14368.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19679.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 15137.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 24220.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13472.75, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 14532.4, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13684.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15137.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15137.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16973.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 28005.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 13684.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 13684.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 15137.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13684.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13684.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15137.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 15894.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13958.09, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose Inj 5% - 00338055111", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00338055111", "type": "NDC" }, { "code": "J7070", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 8.63, "10th_percentile": 8.63, "90th_percentile": 10.47, "count": "1 through 10" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40074.0, "minimum": 19908.8, "maximum": 74137.6955, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36153.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36876.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 37961.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 52096.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 40074.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 64119.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 35666.24, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 38471.45, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36153.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40074.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40074.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59656.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 74137.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 36153.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 36153.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 40074.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 36153.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36153.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 40074.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 42078.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36876.77, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 20 Mg/5Ml", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "63323016505", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 10.32, "10th_percentile": 10.32, "90th_percentile": 41.47, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 6.11, "10th_percentile": 3.32, "90th_percentile": 22.33, "count": "61" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9886.0, "minimum": 6280.4, "maximum": 23547.5952, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8952.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9131.25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 9399.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12852.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 9886.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 15817.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 8798.67, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 9490.7, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8952.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9886.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9886.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10568.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 18289.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 8952.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 8952.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 9886.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8952.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8952.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9886.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 10380.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9131.25, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8653.0, "minimum": 6729.0, "maximum": 16009.086, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7841.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7998.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8233.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11249.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8653.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 13845.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7701.67, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8307.42, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7841.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8653.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8653.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7143.15 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 16009.09, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7841.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7841.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8653.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7841.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7841.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8653.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 9086.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7998.41, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23549.0, "minimum": 6924.8, "maximum": 57633.1276, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21264.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21689.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 22327.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 30614.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 23549.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 37679.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 20959.41, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 22607.9, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21264.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23549.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23549.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31982.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 43567.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 21264.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 21264.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 23549.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 21264.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21264.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 23549.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 24727.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21689.38, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 4 Mg/Ml", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323016501", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 10.32, "10th_percentile": 10.32, "90th_percentile": 41.47, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 6.11, "10th_percentile": 3.32, "90th_percentile": 22.33, "count": "61" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42082.0, "minimum": 28132.0, "maximum": 103864.8148, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37963.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38722.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 39861.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 54707.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 42082.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 67332.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 37453.56, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 40399.34, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 37963.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42082.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42082.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48189.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 77852.9, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 37963.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 37963.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 42082.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 37963.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37963.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 42082.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 44186.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38722.46, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6135.0, "minimum": 4486.0, "maximum": 30510.4464, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5572.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5683.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 5851.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 7975.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 6135.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 9816.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 5460.4, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 5889.87, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5572.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6135.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6135.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5172.67 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 11350.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 5572.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 5572.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 6135.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5572.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5572.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6135.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 6442.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5683.9, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 62086.0, "minimum": 19738.4, "maximum": 114859.248, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 55987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57107.25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 58786.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 80711.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 62086.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 99337.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 55256.61, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 59602.64, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 55987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 62086.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 62086.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 112904.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 114859.25, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 55987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 55987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 62086.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 55987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 55987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 62086.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 65190.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 57107.25, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose 5% W/ Sodium Chloride 0.9% - 00338008904", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338008904", "type": "NDC" }, { "code": "J7042", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 17.75, "10th_percentile": 17.75, "90th_percentile": 17.75, "count": "1 through 10" } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [ { "code": "024", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36269.0, "minimum": 16879.2, "maximum": 89363.4436, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33379.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 34361.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 47150.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 36269.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 58031.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 32279.88, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 34818.75, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36269.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36269.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43968.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 67098.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 32725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 32725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 36269.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 32725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 36269.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 38083.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33379.7, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Diagnostic Colonoscopy", "code_information": [ { "code": "45378", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6569.01, "discounted_cash": 1040.0, "minimum": 519.96, "maximum": 6240.5595, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 3937.5, "10th_percentile": 3937.5, "90th_percentile": 3937.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1471.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 957.56 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1061.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1092.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1456.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1109.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 924.97, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 844.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1061.27, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Diag Laparo Separate Proc", "code_information": [ { "code": "49320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8902.77, "discounted_cash": 6763.0, "minimum": 1368.0, "maximum": 8902.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6763.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7820.02 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 5089.74 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6899.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 7102.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8902.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6763.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7210.31, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6013.1, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6763.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3560.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6763.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6763.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6763.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6763.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6763.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6763.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5979.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1368.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6763.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6763.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6899.17, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11523.0, "minimum": 8074.8, "maximum": 27632.1024, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10427.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10636.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 10948.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14980.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 11523.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 18437.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 10255.91, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 11062.55, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10427.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11523.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11523.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12944.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 21318.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 10427.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 10427.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 11523.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10427.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10427.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11523.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 12099.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10636.15, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cysto/Uretero W/Lithotripsy", "code_information": [ { "code": "52356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8624.82, "discounted_cash": 5998.0, "minimum": 1368.0, "maximum": 8398.488, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 1537.5, "10th_percentile": 1537.5, "90th_percentile": 1537.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6632.85 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 4317.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6118.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6298.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8398.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6394.85, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5333.04, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4273.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4994.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2819.05 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5979.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1368.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6118.9, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52214 - OR36052214", "code_information": [ { "code": "52214", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8674.14, "discounted_cash": 3943.0, "minimum": 1045.331, "maximum": 8240.433, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2944.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1916.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4022.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4141.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5521.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4204.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3506.07, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2404.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4022.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DILATE URETHRA STRICTURE", "code_information": [ { "code": "53605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1878.12, "discounted_cash": 3943.0, "minimum": 563.436, "maximum": 1878.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1878.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1878.12 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1878.12 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1766.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1878.12 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1878.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1878.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52281 - OR36052281", "code_information": [ { "code": "52281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6681.25, "discounted_cash": 2338.0, "minimum": 1045.331, "maximum": 6347.1875, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2944.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1916.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2455.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3274.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2493.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2079.17, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1766.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Diltiazem Hcl Iv Soln 125 Mg/25Ml (5 Mg/Ml)", "drug_information": { "unit": 25.0, "type": "ML" }, "code_information": [ { "code": "00641601501", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "DILATION AND CURETTAGE", "code_information": [ { "code": "58120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5200.0, "discounted_cash": 3621.0, "minimum": 519.96, "maximum": 5200.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 3637.57 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2367.55 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3694.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3802.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5070.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3860.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3219.76, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1859.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5200.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3621.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3694.22, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy Chemodenervation", "code_information": [ { "code": "52287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7593.75, "discounted_cash": 2338.0, "minimum": 1045.331, "maximum": 7214.0625, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2944.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1916.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2455.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3274.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2493.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2079.17, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1490.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Diphenhydramine Hcl Cap 25 Mg - 00904723761", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904723761", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 2.49, "10th_percentile": 2.49, "90th_percentile": 2.49, "count": "26" } ] } ] }, { "description": "Cystoscopy And Treatment - 52224 - OR36052224", "code_information": [ { "code": "52224", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8434.47, "discounted_cash": 3943.0, "minimum": 1045.331, "maximum": 8012.7465, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2944.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1916.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4022.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4141.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5521.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4204.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3506.07, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2404.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4022.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Diltiazem Hcl Iv Soln 25 Mg/5Ml (5 Mg/Ml)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00409117101", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Cystourethroscopy", "code_information": [ { "code": "52000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7687.5, "discounted_cash": 780.0, "minimum": 519.96, "maximum": 7303.125, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 780.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1025.07 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 667.18 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 795.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 819.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1092.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 780.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 831.64, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 693.55, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 780.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 677.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 780.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 780.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 780.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 780.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 780.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 780.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4082.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 780.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 780.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 795.75, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Diphenhydramine Hcl Inj 50 Mg/Ml - 00641037625", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641037625", "type": "NDC" }, { "code": "J1200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 10.83, "10th_percentile": 10.83, "90th_percentile": 10.83, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 2.49, "10th_percentile": 2.49, "90th_percentile": 6.41, "count": "17" } ] } ] }, { "description": "Cystoscopy And Treatment - 52240 - OR36052240", "code_information": [ { "code": "52240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9841.55, "discounted_cash": 5998.0, "minimum": 1251.0, "maximum": 9349.4725, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4384.78 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2853.88 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6118.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6298.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8398.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6394.85, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5333.04, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2404.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6118.9, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Diltiazem Hcl Iv Soln 50 Mg/10Ml (5 Mg/Ml) - 00409117102", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00409117102", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10468.0, "minimum": 6729.0, "maximum": 25000.4736, "payers_information": [ { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 16749.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 9317.02, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 10049.82, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9477.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10468.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10468.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9908.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 19366.84, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 9477.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 9477.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 10468.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9477.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9477.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10468.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 10991.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9666.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9477.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9666.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 9950.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13609.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 10468.56, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52310 - OR36052310", "code_information": [ { "code": "52310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7183.45, "discounted_cash": 2338.0, "minimum": 1045.331, "maximum": 8810.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 3937.5, "10th_percentile": 3937.5, "90th_percentile": 3937.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2944.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1916.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2455.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3274.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2493.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2079.17, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1766.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Diphenhydramine Hcl Cap 25 Mg - 00904530661", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904530661", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 2.49, "10th_percentile": 2.49, "90th_percentile": 2.49, "count": "26" } ] } ] }, { "description": "CYSTOURETERO & OR PYELOSCOPE", "code_information": [ { "code": "52351", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2562.1, "discounted_cash": 3943.0, "minimum": 768.63, "maximum": 2562.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2562.1 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2562.1 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2404.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2562.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2562.1, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Diphenhydramine Hcl Liquid 12.5 Mg/5Ml - 00121048910", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00121048910", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 2.49, "10th_percentile": 2.49, "90th_percentile": 2.49, "count": "26" } ] } ] }, { "description": "Cystouretero W/Lithotripsy", "code_information": [ { "code": "52353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13150.7, "discounted_cash": 5998.0, "minimum": 1368.0, "maximum": 12493.165, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6632.85 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 4317.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6118.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6298.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8398.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6394.85, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5333.04, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3370.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5979.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1368.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5998.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6118.9, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Diphenhydramine Hcl Liquid 12.5 Mg/5Ml - 00603082394", "drug_information": { "unit": 118.0, "type": "ML" }, "code_information": [ { "code": "00603082394", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 2.49, "10th_percentile": 2.49, "90th_percentile": 2.49, "count": "26" } ] } ] }, { "description": "Cystouretero W/Stone Remove", "code_information": [ { "code": "52352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7687.5, "discounted_cash": 3943.0, "minimum": 1251.0, "maximum": 7303.125, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4384.78 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2853.88 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4022.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4141.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5521.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4204.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3506.07, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2404.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4022.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Diphenhydramine Hcl Liquid 12.5 Mg/5Ml - 58657052804", "drug_information": { "unit": 118.0, "type": "ML" }, "code_information": [ { "code": "58657052804", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 2.49, "10th_percentile": 2.49, "90th_percentile": 2.49, "count": "26" } ] } ] }, { "description": "CYSTOURETERO WBIOPSY", "code_information": [ { "code": "52354", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3588.89, "discounted_cash": 5998.0, "minimum": 1076.667, "maximum": 3588.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 3075.0, "10th_percentile": 3075.0, "90th_percentile": 3075.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 3588.89 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2853.88 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2404.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3588.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3588.89, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITH CCMCC", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7626.2, "maximum": 15374.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15374.8 } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19211.0, "minimum": 17097.9057, "maximum": 35540.5905, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17354.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17701.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 18222.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24974.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 19211.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 30737.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17097.91, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 18442.68, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17354.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19211.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19211.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17194.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 35540.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 17354.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 17354.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 19211.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17354.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17354.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19211.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 20171.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17701.69, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15375.0, "minimum": 10766.4, "maximum": 37240.2888, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13898.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14176.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 14593.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19987.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 15375.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 24600.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13683.83, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 14760.09, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13898.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15375.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15375.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18414.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 28443.92, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 13898.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 13898.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 15375.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13898.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13898.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15375.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 16143.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14176.06, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10863.0, "minimum": 4906.48, "maximum": 39682.3124, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10029.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 10324.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14122.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 10863.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 17381.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 9668.28, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 10428.71, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10863.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10863.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4906.48 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 20096.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 9832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 9832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 10863.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10863.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 11406.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10029.28, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15747.0, "minimum": 10093.5, "maximum": 38170.0396, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14233.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14518.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 14945.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20472.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 15747.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 25196.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14015.54, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 15117.89, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14233.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15747.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15747.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15104.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 29133.43, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 14233.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 14233.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 15747.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14233.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14233.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15747.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 16535.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14518.58, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12090.0, "minimum": 7850.5, "maximum": 30416.786, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10938.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11157.07, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 11485.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15717.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 12090.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 19344.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 10760.39, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 11606.72, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10938.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12090.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12090.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13719.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 22367.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 10938.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 10938.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 12090.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10938.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10938.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12090.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 12694.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11157.07, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21720.0, "minimum": 13458.0, "maximum": 53068.8964, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19615.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20007.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 20596.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28236.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 21720.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 34752.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 19331.03, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 20851.45, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19615.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21720.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21720.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27291.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 40182.48, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 19615.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 19615.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 21720.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19615.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19615.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 21720.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 22806.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20007.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19836.0, "minimum": 16077.5, "maximum": 36697.673, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18276.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 18814.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25787.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 19836.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 31738.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17654.56, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 19043.12, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19836.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19836.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16077.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 36697.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 17918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 17918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 19836.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19836.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 20828.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18276.56, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Drain Bl W/Cath Insertion", "code_information": [ { "code": "51102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7687.5, "discounted_cash": 2338.0, "minimum": 519.96, "maximum": 7303.125, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2944.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1916.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2455.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3274.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2493.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2079.17, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1882.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8778.0, "minimum": 6280.4, "maximum": 57658.256, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7953.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8112.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8351.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11411.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8778.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 14044.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7812.51, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8426.98, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7953.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8778.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8778.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9256.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 16239.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7953.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7953.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8778.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7953.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7953.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8778.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 9217.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8112.88, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Egd Lesion Ablation", "code_information": [ { "code": "43270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 2146.0, "minimum": 1183.0, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2126.44 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1384.0 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2189.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2254.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3005.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2288.62, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1908.61, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1310.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2189.86, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Decompression Of Tibia Nerve", "code_information": [ { "code": "28035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6766.07, "discounted_cash": 2184.0, "minimum": 1251.0, "maximum": 6427.7665, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1739.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2184.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2184.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2184.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2184.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2184.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2184.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2184.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2184.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2228.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2184.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2721.68 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1771.44 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2228.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2293.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3058.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2184.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2328.94, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1942.24, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2184.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16168.0, "minimum": 9869.2, "maximum": 102382.2392, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14612.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14904.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 15343.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21018.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 16168.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 25868.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14389.63, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 15521.4, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14612.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16168.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16168.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18230.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 29911.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 14612.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 14612.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 16168.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14612.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14612.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16168.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 16976.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14904.95, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Durvalumab Soln For Iv Infusion 120 Mg/2.4Ml (50 Mg/Ml)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00310450012", "type": "NDC" }, { "code": "J9173", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 86.0, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 52754.56, "10th_percentile": 52754.56, "90th_percentile": 53809.55, "count": "1 through 10" } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 10 Mg/Ml - 00641036721", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641036721", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 10.32, "10th_percentile": 10.32, "90th_percentile": 41.47, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 6.11, "10th_percentile": 3.32, "90th_percentile": 22.33, "count": "61" } ] } ] }, { "description": "Enalaprilat Iv Inj 1.25 Mg/Ml - 00143978710", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00143978710", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 194814.0, "minimum": 104304.8, "maximum": 484868.4688, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 175584.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 179095.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 184363.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 253258.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 194814.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 311702.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 173384.77, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 187021.78, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 175584.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 194814.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 194814.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 291619.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 360406.55, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 175584.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 175584.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 194814.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 175584.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 175584.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 194814.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 204555.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 179095.68, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Tab 0.5 Mg - 00054417925", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00054417925", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4.28, "10th_percentile": 4.28, "90th_percentile": 4.28, "count": "1 through 10" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15520.0, "minimum": 11215.0, "maximum": 28713.295, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14029.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14309.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 14730.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20176.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 15520.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 24833.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13813.42, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 14899.87, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14029.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15520.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15520.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16722.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 28713.3, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 14029.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 14029.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 15520.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14029.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14029.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15520.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 16296.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14309.89, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Tab 0.5 Mg - 00054817925", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00054817925", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4.28, "10th_percentile": 4.28, "90th_percentile": 4.28, "count": "1 through 10" } ] } ] }, { "description": "Egd Varices Ligation", "code_information": [ { "code": "43244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 2146.0, "minimum": 813.14, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2126.44 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1384.0 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2189.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2254.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3005.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2288.62, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1908.61, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 813.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2189.86, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dexmedetomidine Hcl In Nacl 0.9% Iv Soln 400 Mcg/100Ml", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00409166010", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Endometr Ablate Thermal", "code_information": [ { "code": "58353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 5596.0, "minimum": 1324.0, "maximum": 6562.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6562.5 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 4656.03 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5708.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 5876.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6562.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5966.26, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 4975.62, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3166.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5854.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5596.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5708.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dexmedetomidine Hcl In Nacl 0.9% Iv Soln 200 Mcg/50Ml", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00409166050", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "ENDOSCOPIC INJECTIONIMPLANT", "code_information": [ { "code": "51715", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8625.0, "discounted_cash": 3943.0, "minimum": 1045.331, "maximum": 8193.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4384.78 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2853.88 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4022.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4141.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5521.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4204.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3506.07, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2876.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5854.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4022.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dexmedetomidine Hcl Iv Soln 200 Mcg/2Ml - 42023014625", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "42023014625", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Enalaprilat Iv Soln 1.25 Mg/Ml", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00143978710", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Dextrose 5% W/ Sodium Chloride 0.2%", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00264761600", "type": "NDC" }, { "code": "J7060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 17.7, "10th_percentile": 17.7, "90th_percentile": 17.7, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 10.47, "10th_percentile": 8.57, "90th_percentile": 17.75, "count": "94" } ] } ] }, { "description": "Dexmedetomidine Hcl-Dextrose Iv Soln 400 Mcg/100Ml-5%", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "44567060324", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9833.0, "minimum": 7626.2, "maximum": 18191.1055, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8904.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9082.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 9349.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12782.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 9833.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 15732.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 8751.4, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 9439.71, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8904.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9833.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9833.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9259.15 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 18191.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 8904.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 8904.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 9833.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8904.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8904.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9833.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 10324.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9082.44, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose 5% W/ Sodium Chloride 0.9% - 00264761000", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00264761000", "type": "NDC" }, { "code": "J7042", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 17.75, "10th_percentile": 17.75, "90th_percentile": 17.75, "count": "1 through 10" } ] } ] }, { "description": "Dextrose 5% In Lactated Ringers", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00264775100", "type": "NDC" }, { "code": "J7121", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 14.2, "10th_percentile": 14.2, "90th_percentile": 14.2, "count": "1 through 10" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7482.0, "minimum": 5808.82, "maximum": 107398.7816, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6786.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6921.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7125.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9727.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 7482.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 11971.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6659.27, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7183.04, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6786.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7482.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7482.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5808.82 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 13842.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6786.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6786.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 7482.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6786.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6786.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7482.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 7856.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6921.95, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose Inj 70%", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00264129055", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Dextrose Inj 5% - 00264151031 - 25800000", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00264151031", "type": "NDC" }, { "code": "J7070", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 8.63, "10th_percentile": 8.63, "90th_percentile": 10.47, "count": "1 through 10" } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13603.0, "minimum": 12062.0, "maximum": 25165.809, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12301.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12547.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 12916.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17684.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 13603.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 21765.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 12106.79, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 13059.01, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12301.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13603.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13603.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12062.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 25165.81, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 12301.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 12301.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 13603.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12301.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12301.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13603.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 14283.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12547.43, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Diagnostic Sigmoidoscopy", "code_information": [ { "code": "45330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1040.0, "minimum": 519.96, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 962.46 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 626.43 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1061.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1092.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1456.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1109.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 924.97, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 527.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4082.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1061.27, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20031.0, "minimum": 12560.8, "maximum": 48856.4628, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18455.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 18998.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26041.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 20031.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 32050.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 17828.15, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 19230.36, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20031.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20031.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24507.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 37058.52, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 18093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 18093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 20031.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 18093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20031.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 21033.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18455.78, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ephedrine Sulfate 10 Mg/Ml Ij Soln", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "52533011815", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Diltiazem Hcl 125 Mg/125Ml In Dextrose 5% Iv Soln (1 Mg/Ml)", "drug_information": { "unit": 125.0, "type": "ML" }, "code_information": [ { "code": "70092157536", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8910.0, "minimum": 5158.9, "maximum": 21114.7092, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8073.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8234.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8477.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11584.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8910.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 14257.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7930.68, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8554.44, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8073.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8910.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8910.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10019.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 16485.13, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 8073.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 8073.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8910.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8073.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8073.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8910.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 9356.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8234.91, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ephedrine Sulfate Inj 50 Mg/Ml - 00781326995", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00781326995", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Diltiazem Hcl 125 Mg/125Ml In Dextrose 5% Iv Soln - 52533010313", "drug_information": { "unit": 125.0, "type": "ML" }, "code_information": [ { "code": "52533010313", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Ephedrine Sulfate Inj 50 Mg/Ml - 17478051500", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "17478051500", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Diphenhydramine Hcl Elixir 12.5 Mg/5Ml", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00121048910", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 2.49, "10th_percentile": 2.49, "90th_percentile": 2.49, "count": "26" } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12639.0, "minimum": 8074.8, "maximum": 23383.593, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11433.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11662.07, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 12005.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16431.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 12639.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 20223.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 11249.4, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 12134.19, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11433.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12639.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12639.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17304.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 23383.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 11433.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 11433.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 12639.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11433.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11433.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12639.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 13271.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11662.07, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Diltiazem Hcl 125 Mg/125Ml In Dextrose 5% Iv Soln - 66647615411", "drug_information": { "unit": 125.0, "type": "ML" }, "code_information": [ { "code": "66647615411", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Diphenhydramine Hcl Inj 50 Mg/Ml - 63323066401", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323066401", "type": "NDC" }, { "code": "J1200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 10.83, "10th_percentile": 10.83, "90th_percentile": 10.83, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 2.49, "10th_percentile": 2.49, "90th_percentile": 6.41, "count": "17" } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7168.0, "minimum": 4934.6, "maximum": 35716.594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6503.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6633.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 6828.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9318.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 7168.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 11469.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6379.72, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 6881.5, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6503.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7168.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7168.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5617.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 13261.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6503.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6503.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 7168.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6503.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6503.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7168.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 7526.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6633.27, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Diltiazem Hcl Iv Soln 50 Mg/10Ml (5 Mg/Ml) - 00641601301", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00641601301", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16881.0, "minimum": 10766.4, "maximum": 40998.1268, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15255.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15560.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 16018.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21945.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 16881.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 27010.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15024.53, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 16206.23, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15255.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16881.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16881.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20398.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 31230.76, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 15255.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 15255.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 16881.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15255.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15255.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16881.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 17725.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15560.51, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "443", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6854.0, "minimum": 5383.2, "maximum": 15983.9468, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6220.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6344.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 6531.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 8910.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 6854.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 10966.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6100.18, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 6579.96, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6220.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6854.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6854.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6774.32 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 12680.14, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6220.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6220.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 6854.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6220.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6220.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6854.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 7196.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6344.58, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9286.0, "minimum": 7177.6, "maximum": 22051.3132, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8411.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8579.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8832.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12072.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 9286.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 14858.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 8264.84, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8914.89, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8411.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9286.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9286.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10519.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 17179.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 8411.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 8411.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 9286.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8411.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8411.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9286.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 9750.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8579.99, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8149.0, "minimum": 6729.0, "maximum": 19216.3728, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7535.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7757.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10594.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8149.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 13039.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7253.41, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7823.9, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8149.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8149.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8595.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 15077.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8149.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8149.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8557.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7535.51, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ercp Duct Stent Placement", "code_information": [ { "code": "43274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7512.5, "discounted_cash": 6792.0, "minimum": 1045.331, "maximum": 17164.41, "payers_information": [ { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6792.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6792.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6792.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6792.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6792.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6792.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6792.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6928.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6792.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7062.52 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 4596.71 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6928.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 7131.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7512.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6792.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7240.57, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6038.34, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6792.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2500.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6792.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6137.0, "minimum": 5158.9, "maximum": 14195.2616, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5574.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5685.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 5852.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 7978.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 6137.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 9819.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 5462.03, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 5891.63, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5574.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6137.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6137.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6460.76 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 11353.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 5574.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 5574.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 6137.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5574.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5574.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6137.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 6443.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5685.58, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8022.0, "minimum": 4934.6, "maximum": 18898.8412, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7273.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7418.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7636.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10429.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8022.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 12836.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7140.13, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7701.72, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7273.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8022.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8022.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7554.85 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 14841.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7273.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7273.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8022.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7273.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7273.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8022.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8423.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7418.52, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12061.0, "minimum": 8523.4, "maximum": 28973.0452, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10911.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11130.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 11457.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15679.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 12061.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 19297.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 10734.32, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 11578.59, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10911.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12061.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12061.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11681.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 22312.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 10911.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 10911.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 12061.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10911.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10911.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12061.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 12664.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11130.14, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18452.0, "minimum": 6536.6, "maximum": 34137.865, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16671.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17004.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 17504.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23988.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 18452.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 29524.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16423.08, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 17714.78, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16671.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18452.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18452.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13827.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 34137.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 16671.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 16671.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 18452.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16671.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16671.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18452.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 19375.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17004.83, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Abd Les Sc 3 Cm/>", "code_information": [ { "code": "22903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7681.43, "discounted_cash": 3249.0, "minimum": 1251.0, "maximum": 7297.3585, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2197.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc foottoe tum sc 1.5 cm>", "code_information": [ { "code": "28039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5866.91, "discounted_cash": 3249.0, "minimum": 1251.0, "maximum": 5685.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2197.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 2.1-3", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1847.0, "minimum": 1045.331, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1841.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1198.26 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1494.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Leg/Ankle Tum < 3 Cm", "code_information": [ { "code": "27618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1847.0, "minimum": 1045.331, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1494.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Edrophonium Chloride Inj 10 Mg/Ml", "drug_information": { "unit": 15.0, "type": "ML" }, "code_information": [ { "code": "67457019015", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Exc Leg/Ankle Tum Deep <5 Cm", "code_information": [ { "code": "27619", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9873.57, "discounted_cash": 3249.0, "minimum": 1183.0, "maximum": 9379.8915, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2052.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Egd Diagnostic Brush Wash", "code_information": [ { "code": "43235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6615.28, "discounted_cash": 1014.0, "minimum": 519.96, "maximum": 6284.516, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1456.76 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 948.15 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1035.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1065.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1420.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1081.72, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 902.11, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 813.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1035.05, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Esmolol Hcl-Sodium Chloride Iv Soln 2500 Mg/250Ml", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "10019005561", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Drainage Of Scrotum", "code_information": [ { "code": "54700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10362.5, "discounted_cash": 2338.0, "minimum": 1045.331, "maximum": 9844.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2944.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1916.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2455.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3274.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2493.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2079.17, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2146.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc legankle les sc 3 cm>", "code_information": [ { "code": "27632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2504.16, "discounted_cash": 3249.0, "minimum": 751.248, "maximum": 2504.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2504.16 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2197.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2504.16 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2504.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2504.16, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Egd Place Gastrostomy Tube", "code_information": [ { "code": "43246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 2146.0, "minimum": 813.14, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2126.44 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1384.0 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2189.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2254.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3005.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2288.62, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1908.61, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 813.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2189.86, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Esoph Egd Dilation <30 Mm", "code_information": [ { "code": "43249", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 2146.0, "minimum": 519.96, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2126.44 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1384.0 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2189.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2254.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3005.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2288.62, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1908.61, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 813.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2189.86, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7329.0, "minimum": 4261.7, "maximum": 27006.1768, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6648.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6781.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 6980.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9528.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 7329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 11727.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6523.17, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7036.22, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6648.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8662.48 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 13559.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6648.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6648.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 7329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6648.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6648.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 7695.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6781.4, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Neck Les Sc < 3 Cm", "code_information": [ { "code": "21555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1847.0, "minimum": 1045.331, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2052.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Egd Remove Foreign Body", "code_information": [ { "code": "43247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7504.55, "discounted_cash": 1014.0, "minimum": 813.14, "maximum": 7129.3225, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1456.76 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 948.15 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1035.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1065.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1420.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1081.72, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 902.11, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 813.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1035.05, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7585.0, "minimum": 5607.5, "maximum": 17809.1824, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6879.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7017.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7223.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9861.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 7585.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 12137.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6751.37, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7282.38, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6879.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7585.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7585.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7273.99 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 14033.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6879.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6879.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 7585.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6879.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6879.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7585.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 7965.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7017.06, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7746.0, "minimum": 4710.3, "maximum": 16767.496, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7023.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7164.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7375.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10069.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 7746.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 12393.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6893.99, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7436.22, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7023.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7746.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7746.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10025.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 14330.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7023.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7023.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 7746.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7023.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7023.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7746.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8133.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7164.35, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Neck Tum Deep < 5 Cm", "code_information": [ { "code": "21556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 3249.0, "minimum": 1045.331, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2052.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Enalaprilat Iv Inj 1.25 Mg/Ml - 00409212202", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409212202", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Egd Biopsy Single/Multiple", "code_information": [ { "code": "43239", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6595.28, "discounted_cash": 1014.0, "minimum": 519.96, "maximum": 6265.516, "payers_information": [ { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1035.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1065.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1420.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1081.72, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 902.11, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 813.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 519.96, "10th_percentile": 519.96, "90th_percentile": 519.96, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1035.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 2625.0, "10th_percentile": 1022.84, "90th_percentile": 3937.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1456.76 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 948.15 } ] } ] }, { "description": "Exc Rect Tum Transanal Part", "code_information": [ { "code": "45171", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6937.5, "discounted_cash": 3105.0, "minimum": 1045.331, "maximum": 6590.625, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3105.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4547.29 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2959.66 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3167.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3260.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4347.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3105.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3310.44, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2760.77, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3105.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1326.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3105.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3105.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3105.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3105.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3105.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3105.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3105.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3105.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3167.59, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 56566.0, "minimum": 11252.8, "maximum": 108755.7152, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 51014.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52034.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 53565.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 73536.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 56566.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 90507.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 50344.55, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 54304.23, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51014.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 56566.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 56566.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47378.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 104648.78, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 51014.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 51014.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 56566.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 51014.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 51014.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 56566.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 59395.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 52034.69, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Etoposide Inj 100 Mg/5Ml (20 Mg/Ml) - 00703565601", "drug_information": { "unit": 25.0, "type": "ML" }, "code_information": [ { "code": "00703565601", "type": "NDC" }, { "code": "J9181", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 76.69, "10th_percentile": 64.58, "90th_percentile": 80.73, "count": "12" } ] } ] }, { "description": "Egd Control Bleeding Any", "code_information": [ { "code": "43255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 2146.0, "minimum": 813.14, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2126.44 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1384.0 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2189.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2254.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3005.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2288.62, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1908.61, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 813.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2189.86, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Shoulder Les Sc < 3 Cm", "code_information": [ { "code": "23075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1847.0, "minimum": 1045.331, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1494.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Abdl Tum Deep 5 Cm/>", "code_information": [ { "code": "22901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9873.57, "discounted_cash": 3249.0, "minimum": 1251.0, "maximum": 9379.8915, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2197.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Egd Dilate Stricture", "code_information": [ { "code": "43245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 2146.0, "minimum": 813.14, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2126.44 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1384.0 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2189.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2254.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3005.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2288.62, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1908.61, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 813.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2146.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2189.86, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc skn hdrdnt ing smplntrm", "code_information": [ { "code": "11462", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 3249.0, "minimum": 1045.331, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2052.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Back Tum Deep 5 Cm/>", "code_information": [ { "code": "21933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6879.17, "discounted_cash": 3249.0, "minimum": 1251.0, "maximum": 6535.2115, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2197.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44043.0, "minimum": 4564.72, "maximum": 157118.7476, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40524.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 41716.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 57256.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 44043.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 70469.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 39198.49, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 42281.52, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44043.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44043.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4564.72 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 81480.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 39729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 39729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 44043.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 39729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 44043.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 46245.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40524.4, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Thigh/Knee Tum Dep 5Cm/>", "code_information": [ { "code": "27339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 3249.0, "minimum": 1251.0, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2197.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc F/E/E/N/L Mal+Mrg 0.5Cm<", "code_information": [ { "code": "11640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 792.0, "minimum": 256.431, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1841.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1198.26 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 831.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1109.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 844.56, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 704.33, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 775.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 256.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4082.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc tr-ext b9+marg 0.5 cm<", "code_information": [ { "code": "11400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3281.26, "discounted_cash": 792.0, "minimum": 256.431, "maximum": 3281.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 939.38 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 611.4 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 831.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1109.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 844.56, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 704.33, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 420.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 256.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3281.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Face Les Sbq 2 Cm/>", "code_information": [ { "code": "21012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7037.5, "discounted_cash": 1847.0, "minimum": 519.96, "maximum": 6685.625, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4082.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 770.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [ { "code": "927", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 195961.0, "minimum": 53832.0, "maximum": 362529.2745, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 176618.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 180150.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 185448.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 254750.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 195961.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 313538.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 174405.98, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 188123.3, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 176618.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 195961.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 195961.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 297009.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 362529.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 176618.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 176618.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 195961.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 176618.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 176618.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 195961.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 205759.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 180150.36, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Foot/Toe Tum Dep 1.5Cm/>", "code_information": [ { "code": "28041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7512.5, "discounted_cash": 3249.0, "minimum": 1251.0, "maximum": 7136.875, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2197.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [ { "code": "933", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36107.0, "minimum": 11252.8, "maximum": 66798.7825, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32579.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33230.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 34208.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 46939.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 36107.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 57771.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 32135.63, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 34663.15, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32579.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36107.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36107.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54173.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 66798.78, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 32579.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 32579.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 36107.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 32579.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32579.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 36107.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 37912.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33230.78, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ephedrine Sulfate Prefilled Syringe 25 Mg/5Ml (5 Mg/Ml)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "62295308405", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Exc Forearm Les Sc < 3 Cm", "code_information": [ { "code": "25075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1847.0, "minimum": 1045.331, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1494.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11211.0, "minimum": 5193.6, "maximum": 26853.122, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10146.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10349.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 10653.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14574.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 11211.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 17937.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 9977.99, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 10762.77, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10146.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11211.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11211.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18466.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 20740.76, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 10146.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 10146.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 11211.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10146.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10146.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11211.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 11771.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10349.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc hand les sc 1.5 cm>", "code_information": [ { "code": "26111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 417.36, "discounted_cash": 1847.0, "minimum": 125.208, "maximum": 417.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 417.36 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 417.36 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 417.36 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 417.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 417.36 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 417.36 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 417.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 417.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 417.36, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fam-Trastuzumab Deruxtecan-Nxki For Iv Soln 100 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "65597040601", "type": "NDC" }, { "code": "J9358", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 31.0, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 44178.47, "10th_percentile": 1314.83, "90th_percentile": 50008.14, "count": "31" } ] } ] }, { "description": "Exc Hip Pelvis Les Sc 3 Cm/>", "code_information": [ { "code": "27043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7512.5, "discounted_cash": 3249.0, "minimum": 1251.0, "maximum": 7136.875, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2197.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Famotidine Inj 20 Mg/2Ml", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "63323073820", "type": "NDC" }, { "code": "J1308", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 3.83, "10th_percentile": 3.79, "90th_percentile": 3.83, "count": "29" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "median_amount": 7.24, "10th_percentile": 6.48, "90th_percentile": 7.24, "count": "17" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 6.48, "10th_percentile": 6.48, "90th_percentile": 6.48, "count": "1 through 10" } ] } ] }, { "description": "Exc S/N/H/F/G Mal+Mrg 1.1-2", "code_information": [ { "code": "11622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 792.0, "minimum": 519.96, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1841.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1198.26 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 831.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1109.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 844.56, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 704.33, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 775.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4082.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fentanyl Citrate Preservative Free (Pf) Inj 100 Mcg/2Ml - 00409909422", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409909422", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 6.56, "10th_percentile": 3.05, "90th_percentile": 14.95, "count": "33" } ] } ] }, { "description": "Exc Shoulder Tum Deep < 5 Cm", "code_information": [ { "code": "23076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 3249.0, "minimum": 1045.331, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2052.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Skn H/P/P/U Smpl/Ntrm", "code_information": [ { "code": "11470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 3249.0, "minimum": 1045.331, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2052.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Thigh/Knee Les Sc < 3 Cm", "code_information": [ { "code": "27327", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1847.0, "minimum": 1045.331, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2052.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ethiodized Inj Oil 480 Mg/Ml (Iodine Equivalent)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "67684190102", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 0.6-1 Cm", "code_information": [ { "code": "11401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 454.0, "minimum": 256.431, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 454.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 939.38 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 611.4 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 463.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 477.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 636.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 454.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 484.83, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 404.33, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 454.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 420.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 454.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 454.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 454.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 454.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 256.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 454.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 454.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3774.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 454.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 454.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.91, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Ethiodized Oil 480 Mg/Ml Injection", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "60694190100", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Fluorouracil Inj 500 Mg/10Ml (50 Mg/Ml) - 16729027638", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "16729027638", "type": "NDC" }, { "code": "J9190", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 43.67, "10th_percentile": 43.67, "90th_percentile": 117.15, "count": "16" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 1.1-2 Cm", "code_information": [ { "code": "11402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 792.0, "minimum": 256.431, "maximum": 6234.375, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4082.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 939.38 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 611.4 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 831.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1109.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 844.56, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 704.33, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 420.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 256.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Etoposide Inj 100 Mg/5Ml (20 Mg/Ml) - 16729011431", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "16729011431", "type": "NDC" }, { "code": "J9181", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 76.69, "10th_percentile": 64.58, "90th_percentile": 80.73, "count": "12" } ] } ] }, { "description": "Fluorouracil Iv Soln 5 Gm/100Ml (50 Mg/Ml)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "16729027638", "type": "NDC" }, { "code": "J9190", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 43.67, "10th_percentile": 43.67, "90th_percentile": 117.15, "count": "16" } ] } ] }, { "description": "Exchange Nephrostomy Cath", "code_information": [ { "code": "50435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12370.7, "discounted_cash": 2338.0, "minimum": 613.0, "maximum": 11752.165, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1025.07 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 667.18 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2455.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3274.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2493.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2079.17, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 668.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4082.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2338.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2385.55, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "EXC ABD LES SC < 3 CM", "code_information": [ { "code": "22902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1028.99, "discounted_cash": 1847.0, "minimum": 308.697, "maximum": 1028.99, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1028.99 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1028.99 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1028.99 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1028.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1028.99 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1028.99 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1028.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1028.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1028.99, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fluorouracil Iv Soln 500 Mg/10Ml (50 Mg/Ml)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323011710", "type": "NDC" }, { "code": "J9190", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 43.67, "10th_percentile": 43.67, "90th_percentile": 117.15, "count": "16" } ] } ] }, { "description": "Excision Breast Lesion", "code_information": [ { "code": "19125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9873.57, "discounted_cash": 4380.0, "minimum": 1045.331, "maximum": 9379.8915, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4276.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2783.21 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4468.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4599.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6132.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4669.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3894.43, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2019.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4380.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4468.3, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Arm/Elbow Les Sc < 3 Cm", "code_information": [ { "code": "24075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1847.0, "minimum": 1045.331, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1494.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "982", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22960.0, "minimum": 17744.8, "maximum": 42476.3145, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20732.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21147.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 21769.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29848.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 22960.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 36736.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 20434.55, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 22041.76, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20732.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22960.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22960.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26810.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 42476.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 20732.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 20732.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 22960.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 20732.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20732.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22960.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 24108.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21147.35, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Arm/Elbow Les Sc 3 Cm/>", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 3249.0, "minimum": 1251.0, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2197.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43411.0, "minimum": 19514.1, "maximum": 80311.0715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39160.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39943.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 41118.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 56434.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 43411.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 69458.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 38636.14, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 41674.93, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39160.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43411.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43411.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 63139.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 80311.07, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 39160.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 39160.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 43411.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 39160.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39160.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 43411.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 45581.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 39943.71, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Back Tum Deep < 5 Cm", "code_information": [ { "code": "21932", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 3249.0, "minimum": 1045.331, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1644.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [ { "code": "790", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54873.0, "minimum": 8284.62, "maximum": 101516.3635, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 49488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50478.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 51963.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 71335.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 54873.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 87797.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 48837.6, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 52678.76, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 49488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54873.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54873.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8284.62 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 101516.36, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 49488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 49488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 54873.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 49488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 49488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 54873.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 57617.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 50478.47, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Face Les Sc <2 Cm", "code_information": [ { "code": "21011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1847.0, "minimum": 519.96, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1841.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1198.26 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 770.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4082.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17563.0, "minimum": 15631.7019, "maximum": 42700.0048, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15870.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16187.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 16663.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22832.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 17563.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 28101.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15631.7, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 16861.16, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15870.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17563.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17563.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21468.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 32492.86, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 15870.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 15870.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 17563.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15870.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15870.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17563.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 18441.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16187.6, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Esmolol Hcl Inj 100 Mg/10Ml", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323065210", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Famotidine In Nacl 0.9% Iv Soln 20 Mg/50Ml", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00338519741", "type": "NDC" }, { "code": "J1308", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 3.83, "10th_percentile": 3.79, "90th_percentile": 3.83, "count": "29" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "median_amount": 7.24, "10th_percentile": 6.48, "90th_percentile": 7.24, "count": "17" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 6.48, "10th_percentile": 6.48, "90th_percentile": 6.48, "count": "1 through 10" } ] } ] }, { "description": "Exc Foot/Toe Tum Deep <1.5Cm", "code_information": [ { "code": "28045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8462.5, "discounted_cash": 3249.0, "minimum": 1183.0, "maximum": 8039.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2031.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Etomidate Iv Soln 2 Mg/Ml", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00409669501", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Fentanyl Citrate Preservative Free (Pf) Inj 100 Mcg/2Ml - 00409909332", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409909332", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 6.56, "10th_percentile": 3.05, "90th_percentile": 14.95, "count": "33" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 0.6-1", "code_information": [ { "code": "11421", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 792.0, "minimum": 519.96, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1841.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1198.26 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 831.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1109.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 844.56, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 704.33, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 775.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4082.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [ { "code": "562", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13494.0, "minimum": 9196.3, "maximum": 24964.196, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12203.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12447.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 12813.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17542.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 13494.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 21590.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 12009.8, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 12954.39, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12203.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13494.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13494.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14677.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 24964.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 12203.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 12203.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 13494.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12203.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12203.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13494.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 14168.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12447.37, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "EXC ABDL TUM DEEP < 5 CM", "code_information": [ { "code": "22900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7687.5, "discounted_cash": 3249.0, "minimum": 1251.0, "maximum": 7303.125, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2052.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fentanyl Citrate Preservative Free (Pf) Inj 250 Mcg/5Ml", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00409909335", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 6.56, "10th_percentile": 3.05, "90th_percentile": 14.95, "count": "33" } ] } ] }, { "description": "EXC HIPPELVIS LES SC < 3 CM", "code_information": [ { "code": "27047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3489.93, "discounted_cash": 3249.0, "minimum": 1045.331, "maximum": 3489.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3489.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2052.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3489.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7842.0, "minimum": 6280.4, "maximum": 21800.0292, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7110.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7252.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7466.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10194.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 7842.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 12547.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6979.58, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7528.53, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7110.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7842.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7842.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7188.28 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 14508.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7110.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7110.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 7842.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7110.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7110.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7842.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8234.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7252.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Back Les Sc < 3 Cm", "code_information": [ { "code": "21930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1847.0, "minimum": 1045.331, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2052.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8575.0, "minimum": 6056.1, "maximum": 34227.1652, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7926.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8160.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11148.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8575.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 13721.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7632.39, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8232.69, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8575.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8575.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7123.98 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 15865.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7771.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8575.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8575.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 9004.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7926.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Shoulder Les Sc 3 Cm/>", "code_information": [ { "code": "23071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1847.0, "minimum": 1251.0, "maximum": 6234.375, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2197.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38629.0, "minimum": 5926.2, "maximum": 71464.39, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34851.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35548.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 36594.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 50218.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 38629.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 61807.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 34380.17, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 37084.22, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34851.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38629.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38629.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52215.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 71464.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 34851.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 34851.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 38629.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 34851.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34851.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 38629.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 40560.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35548.63, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Back Les Sc 3 Cm/>", "code_information": [ { "code": "21931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7069.17, "discounted_cash": 1847.0, "minimum": 1251.0, "maximum": 6715.7115, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2197.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Skn Hdrdnt Ax Smpl/Ntrm", "code_information": [ { "code": "11450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7512.5, "discounted_cash": 3249.0, "minimum": 1045.331, "maximum": 7136.875, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2052.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Furosemide Inj 10 Mg/Ml - 63323028002", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "63323028002", "type": "NDC" }, { "code": "J1938", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 7.97, "10th_percentile": 7.97, "90th_percentile": 7.97, "count": "1 through 10" } ] } ] }, { "description": "Exc Face-Mm B9+Marg 0.6-1 Cm", "code_information": [ { "code": "11441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 792.0, "minimum": 256.431, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 939.38 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 611.4 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 831.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1109.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 844.56, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 704.33, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 420.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 256.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4082.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fluorouracil Inj 500 Mg/10Ml (50 Mg/Ml) - 63323011710", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323011710", "type": "NDC" }, { "code": "J9190", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 43.67, "10th_percentile": 43.67, "90th_percentile": 117.15, "count": "16" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg >4.0 Cm", "code_information": [ { "code": "11406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6800.0, "discounted_cash": 1847.0, "minimum": 1045.331, "maximum": 6683.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1494.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Big Toe Joint - 28750 - OR36028750", "code_information": [ { "code": "28750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9878.22, "discounted_cash": 8118.0, "minimum": 1423.0, "maximum": 9878.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 5280.22, "10th_percentile": 5280.22, "90th_percentile": 5280.22, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9712.14 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 6321.25 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8280.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 8524.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9878.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8654.26, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 7217.29, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4444.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6315.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8280.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Face-Mm B9+Marg 1.1-2 Cm", "code_information": [ { "code": "11442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 792.0, "minimum": 519.96, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1841.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1198.26 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 831.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1109.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 844.56, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 704.33, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 775.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4082.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Excise anal ext tagpapilla", "code_information": [ { "code": "46220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2187.5, "discounted_cash": 1338.0, "minimum": 519.96, "maximum": 2187.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2187.5 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2113.55 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1405.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1874.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1427.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2179.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2187.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fusion of big toe joint - 28760 - ", "code_information": [ { "code": "28760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3304.4, "discounted_cash": 8118.0, "minimum": 991.32, "maximum": 3304.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 3304.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 3304.4 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3304.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3304.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3304.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.4, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Forearm Les Sc 3 Cm/>", "code_information": [ { "code": "25071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6879.17, "discounted_cash": 1847.0, "minimum": 1251.0, "maximum": 6535.2115, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2197.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Folic Acid Inj 5 Mg/Ml", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323018410", "type": "NDC" }, { "code": "J1808", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 3.11, "10th_percentile": 3.11, "90th_percentile": 5.45, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "median_amount": 10.28, "10th_percentile": 7.36, "90th_percentile": 10.28, "count": "1 through 10" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "983", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16142.0, "minimum": 8656.0, "maximum": 78318.3696, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14589.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14881.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 15318.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20985.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 16142.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 25827.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 14366.81, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 15496.78, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14589.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16142.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16142.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14324.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 29863.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 14589.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 14589.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 16142.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14589.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14589.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16142.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 16949.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14881.29, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fusion of foot bones - 28715 - ", "code_information": [ { "code": "28715", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7013.94, "discounted_cash": 14364.0, "minimum": 1423.0, "maximum": 7013.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7013.94 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 7013.94 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7013.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7013.94 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5229.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6315.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7013.94, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 0.5/<", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1847.0, "minimum": 519.96, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1841.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1198.26 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 775.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4082.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13150.0, "minimum": 6059.2, "maximum": 58654.2544, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 11704.18, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 12624.73, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11893.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13150.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13150.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21749.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 24328.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 11893.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 11893.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 13150.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11893.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11893.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13150.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 13808.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12131.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11893.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12131.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 12488.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17095.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 13150.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 21041.22, "additional_payer_notes": "160.00% of Medicare Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 1.1-2", "code_information": [ { "code": "11422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1847.0, "minimum": 519.96, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1841.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1198.26 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 775.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4082.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fentanyl Citrate-Nacl 0.9% Iv Soln 1 Mg/100Ml (10 Mcg/Ml) - 70092109236", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "70092109236", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 6.56, "10th_percentile": 3.05, "90th_percentile": 14.95, "count": "33" } ] } ] }, { "description": "Exc Neck Les Sc 3 Cm/>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 3249.0, "minimum": 1251.0, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2197.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fentanyl Infusion 1000 Mcg In Ns", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "52533002475", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 6.56, "10th_percentile": 3.05, "90th_percentile": 14.95, "count": "33" } ] } ] }, { "description": "EXC SHOULDER TUM DEEP 5 CM>", "code_information": [ { "code": "23073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8834.54, "discounted_cash": 3249.0, "minimum": 1251.0, "maximum": 8392.813, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2197.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Gadoterate Meglumine Iv Soln 10 Mmol/20Ml (0.5 Mmol/Ml)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00407294301", "type": "NDC" }, { "code": "A9575", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 234.3, "10th_percentile": 85.2, "90th_percentile": 404.7, "count": "112" } ] } ] }, { "description": "Exc Thigh/Knee Les Sc 3 Cm/>", "code_information": [ { "code": "27337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 3249.0, "minimum": 1251.0, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2197.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITH MCC", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14802.0, "minimum": 13174.4564, "maximum": 27385.106, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13382.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13650.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 14051.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19243.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 14802.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 23684.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13174.46, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 14210.65, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13382.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14802.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14802.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19091.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 27385.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 13382.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 13382.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 14802.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13382.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13382.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14802.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 15542.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13650.05, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5428.0, "minimum": 4827.52, "maximum": 12427.136, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 4935.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5034.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 5182.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 7056.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 5428.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 8685.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 4831.21, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 5211.2, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4935.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4827.52 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 10042.41, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 4935.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 4935.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 5428.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 4935.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4935.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5428.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 5699.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5034.16, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Thigh/Knee Tum Deep <5Cm", "code_information": [ { "code": "27328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 3249.0, "minimum": 1183.0, "maximum": 6234.375, "payers_information": [ { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3412.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4549.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3464.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2889.13, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2052.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3249.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12186.0, "minimum": 8747.7, "maximum": 22545.0065, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11025.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11245.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 11576.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15842.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 12186.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 19498.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 10845.98, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 11699.03, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11025.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12186.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12186.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16650.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 22545.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 11025.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 11025.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 12186.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11025.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11025.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12186.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 12795.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11245.5, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 2.1-3Cm", "code_information": [ { "code": "11403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 792.0, "minimum": 519.96, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1841.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1198.26 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 831.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1109.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 844.56, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 704.33, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 775.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4082.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CCMCC", "code_information": [ { "code": "928", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 66129.0, "minimum": 38805.2, "maximum": 122340.463, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 59631.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 60823.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 62612.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 85968.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 66129.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 105807.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 58855.68, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 63484.78, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 59631.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 66129.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 66129.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38805.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 122340.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 59631.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 59631.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 66129.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 59631.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 59631.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 66129.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 69436.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 60823.93, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Flumazenil Iv Soln 0.5 Mg/5Ml (0.1 Mg/Ml)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "63323042405", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "Gentamicin Sulfate Inj 40 Mg/Ml", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "63323001002", "type": "NDC" }, { "code": "J1580", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 19.77, "10th_percentile": 19.77, "90th_percentile": 19.77, "count": "1 through 10" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 3.1-4 Cm", "code_information": [ { "code": "11404", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 1847.0, "minimum": 519.96, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1841.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1198.26 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1494.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CCMCC", "code_information": [ { "code": "929", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29940.0, "minimum": 19651.9, "maximum": 88959.1048, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27563.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 28373.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 38923.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 29940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 47905.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 26647.36, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 28743.22, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19651.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 55390.57, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 27022.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 29940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 29940.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 31437.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27563.15, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fluorouracil Inj 500 Mg/10Ml (50 Mg/Ml) - 00703301513", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00703301513", "type": "NDC" }, { "code": "J9190", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 43.67, "10th_percentile": 43.67, "90th_percentile": 117.15, "count": "16" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15305.0, "minimum": 8223.2, "maximum": 37066.6744, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14112.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13835.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14112.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 14527.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19897.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 15305.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 24488.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13621.9, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 14693.28, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13835.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15305.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15305.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22600.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 28315.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 13835.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 13835.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 15305.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13835.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13835.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15305.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 16070.78, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Fulvestrant Inj 250 Mg/5Ml - 70860021174", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "70860021174", "type": "NDC" }, { "code": "J9395", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 639.0, "10th_percentile": 426.0, "90th_percentile": 852.0, "count": "15" } ] } ] }, { "description": "HAND PROCEDURES FOR INJURIES", "code_information": [ { "code": "906", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18434.0, "minimum": 13849.6, "maximum": 87704.9692, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16654.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16988.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 17487.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23964.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 18434.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 29495.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 16406.78, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 17697.2, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16654.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18434.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18434.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20999.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 34103.97, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 16654.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 16654.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 18434.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16654.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16654.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18434.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 19356.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16988.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30593.0, "minimum": 21207.2, "maximum": 75204.7324, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27611.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28163.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 28991.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 39771.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 30593.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 48950.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 27228.46, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 29370.03, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27611.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30593.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30593.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51400.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 56598.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 27611.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 27611.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 30593.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 27611.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27611.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 30593.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 32123.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28163.22, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Foot Bones - 28730 - OR36028730", "code_information": [ { "code": "28730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14901.4, "discounted_cash": 14364.0, "minimum": 1423.0, "maximum": 14901.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13806.33 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 8986.01 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14651.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14901.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14901.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14901.4, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12769.83, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4444.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6315.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14651.55, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14502.0, "minimum": 12907.1271, "maximum": 26829.4215, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13111.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13373.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 13767.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18853.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 14502.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 23203.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 12907.13, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 13922.29, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13111.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14502.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14502.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26263.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 26829.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 13111.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 13111.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 14502.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13111.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13111.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14502.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 15227.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13373.93, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7679.0, "minimum": 6513.77, "maximum": 18042.1912, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6963.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7102.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7311.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9982.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 7679.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 12286.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6834.5, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7372.04, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6963.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7679.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7679.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6513.77 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 14206.54, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 6963.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 6963.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 7679.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6963.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6963.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7679.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8063.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7102.9, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26005.0, "minimum": 23145.2688, "maximum": 63759.8884, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23477.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23946.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 24650.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 33807.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 26005.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 41609.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 23145.27, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 24965.68, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23477.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26005.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26005.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33135.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 48110.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 23477.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 23477.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 26005.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 23477.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23477.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 26005.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 27306.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23946.64, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Car Outp Meas Drg Car Cath Eval Cgen Hrt Defect", "code_information": [ { "code": "93598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 888.0, "minimum": 266.4, "maximum": 888.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 888.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 } ] } ] }, { "description": "Fentanyl Citrate-Nacl 0.9% Iv Soln 1 Mg/100Ml (10 Mcg/Ml) - 52533002475", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "52533002475", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 6.56, "10th_percentile": 3.05, "90th_percentile": 14.95, "count": "33" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13970.0, "minimum": 10093.5, "maximum": 33736.0192, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12884.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 13263.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18161.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 13970.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 22352.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 12433.61, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 13411.54, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13970.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13970.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14113.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 25845.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 12632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 12632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 13970.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13970.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 14668.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12884.95, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16864.0, "minimum": 15009.0401, "maximum": 40954.7232, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15239.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15544.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 16001.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21923.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 16864.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 26982.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15009.04, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 16189.53, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15239.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16864.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16864.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16172.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 31198.57, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 15239.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 15239.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 16864.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15239.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15239.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16864.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 17707.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15544.6, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc R&L Hrt Cath Chd Img Cath Trgt Zone Nml Nt Connj", "code_information": [ { "code": "93596", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14807.6, "discounted_cash": 3627.0, "minimum": 913.66, "maximum": 14067.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3627.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5788.13 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3767.26 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3699.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3808.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5078.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3627.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3866.55, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3224.55, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3627.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3457.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3627.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3627.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3627.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3627.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3627.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3627.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5979.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1368.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3627.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 913.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3699.7, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fosaprepitant Dimeglumine For Iv Infusion 150 Mg (Base Eq) - 00006394132", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00006394132", "type": "NDC" }, { "code": "J1453", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 1142.21, "10th_percentile": 350.1, "90th_percentile": 1281.55, "count": "14" } ] } ] }, { "description": "Gentamicin Sulfate Inj 10 Mg/Ml - 63323017301", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "63323017301", "type": "NDC" }, { "code": "J1580", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 19.77, "10th_percentile": 19.77, "90th_percentile": 19.77, "count": "1 through 10" } ] } ] }, { "description": "Fosaprepitant Dimeglumine For Iv Infusion 150 Mg (Base Eq) - 43598094811", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "43598094811", "type": "NDC" }, { "code": "J1453", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 1142.21, "10th_percentile": 350.1, "90th_percentile": 1281.55, "count": "14" } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7828.0, "minimum": 5856.2, "maximum": 29286.008, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7098.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7240.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 7453.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10177.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 7828.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 12525.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 6967.35, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 7515.34, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7098.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7828.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7828.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5856.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 14482.69, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7098.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7098.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 7828.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7098.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7098.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7828.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 8219.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7240.09, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fluphenazine Hcl Inj 2.5 Mg/Ml", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323028110", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 7143.65, "10th_percentile": 7143.65, "90th_percentile": 7143.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.43, "10th_percentile": 3.83, "90th_percentile": 15.71, "count": "1 through 10" } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20690.0, "minimum": 4105.65, "maximum": 47058.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18687.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19060.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 19621.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26897.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 20690.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 33104.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 18414.14, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 19862.45, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18687.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20690.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20690.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4105.65 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 38276.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 18687.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 18687.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 20690.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 18687.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18687.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20690.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 21724.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19060.94, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fulvestrant Inj Soln Pref Syr 250 Mg/5Ml", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00143902202", "type": "NDC" }, { "code": "J9395", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 639.0, "10th_percentile": 426.0, "90th_percentile": 852.0, "count": "15" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [ { "code": "563", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8647.0, "minimum": 6280.4, "maximum": 35261.9984, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7835.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7992.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8227.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11241.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 8647.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 13835.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 7695.96, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 8301.26, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7835.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8647.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8647.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8295.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 15997.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 7835.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 7835.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 8647.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7835.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7835.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8647.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 9079.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7992.52, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "513", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14863.0, "minimum": 13228.2391, "maximum": 27496.9015, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13705.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 14108.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19322.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 14863.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 23781.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 13228.24, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 14268.66, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14863.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14863.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17528.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 27496.9, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 13436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 13436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 14863.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14863.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 15606.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13705.54, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Furosemide Inj 10 Mg/Ml - 36000028325", "drug_information": { "unit": 4.0, "type": "ML" }, "code_information": [ { "code": "36000028325", "type": "NDC" }, { "code": "J1938", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 7.97, "10th_percentile": 7.97, "90th_percentile": 7.97, "count": "1 through 10" } ] } ] }, { "description": "Fragmenting Of Kidney Stone", "code_information": [ { "code": "50590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 3943.0, "minimum": 1423.0, "maximum": 16120.265, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6562.5 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 4317.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4022.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4141.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5521.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 4593.75, "10th_percentile": 4593.75, "90th_percentile": 4593.75, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4204.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3506.07, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3937.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4632.01 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2272.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6315.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4022.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 3937.5, "10th_percentile": 3937.5, "90th_percentile": 3937.5, "count": "1 through 10" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "514", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9808.0, "minimum": 8729.3959, "maximum": 72801.5436, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8882.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9059.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 9326.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12750.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 9808.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 15693.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 8729.4, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 9415.98, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8882.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9808.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9808.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10984.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 18145.37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 8882.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 8882.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 9808.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8882.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8882.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9808.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 10298.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9059.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Furosemide Inj 10 Mg/Ml - 63323028004", "drug_information": { "unit": 4.0, "type": "ML" }, "code_information": [ { "code": "63323028004", "type": "NDC" }, { "code": "J1938", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 7.97, "10th_percentile": 7.97, "90th_percentile": 7.97, "count": "1 through 10" } ] } ] }, { "description": "Fulvestrant Inj 250 Mg/5Ml - 00310072010", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00310072010", "type": "NDC" }, { "code": "J9395", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 639.0, "10th_percentile": 426.0, "90th_percentile": 852.0, "count": "15" } ] } ] }, { "description": "Fusion Of Ankle Joint Open", "code_information": [ { "code": "27870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14364.7, "discounted_cash": 14364.0, "minimum": 1423.0, "maximum": 14364.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14364.7 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 13404.95 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14364.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14364.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14364.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14364.7, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12769.83, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8138.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6315.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14364.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14364.7, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Big Toe Joint - 28755 - OR36028755", "code_information": [ { "code": "28755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9913.22, "discounted_cash": 8118.0, "minimum": 1251.0, "maximum": 9913.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4682.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 3047.36 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8280.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 8524.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9913.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8654.26, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 7217.29, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2031.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8280.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9427.0, "minimum": 6504.7, "maximum": 22403.1108, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8538.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8709.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 8965.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12255.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 9427.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13050.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500.0, "10th_percentile": 13500.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 15083.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 8390.35, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 9050.27, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8538.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9427.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9427.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9864.84 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 17440.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 8538.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", "standard_charge_dollar": 8538.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "case rate", "standard_charge_dollar": 9427.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8538.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8538.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9427.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Behavioral Health", "methodology": "case rate", "standard_charge_dollar": 9898.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8709.6, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Fusion of foot bones - 28740 - ", "code_information": [ { "code": "28740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3234.24, "discounted_cash": 8118.0, "minimum": 970.272, "maximum": 3234.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 3234.24 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 3234.24 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3234.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3234.24 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3234.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3234.24, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17186.0, "minimum": 10093.5, "maximum": 41758.832, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15530.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15840.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "case rate", "standard_charge_dollar": 16306.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22342.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 17186.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "methodology": "case rate", "standard_charge_dollar": 27498.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "case rate", "standard_charge_dollar": 15295.92, "additional_payer_notes": "89.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "case rate", "standard_charge_dollar": 16498.97, "additional_payer_notes": "96.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15530.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17186.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17186.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19108.2 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "case rate", "standard_charge_dollar": 31794.9, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "case rate", "standard_charge_dollar": 15530.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "case rate", 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"payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 545.31 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 683.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 703.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 938.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 670.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { 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"standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4.26, "10th_percentile": 4.26, "90th_percentile": 4.26, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4657) Syringe W/Wo Needle", "code_information": [ { "code": "A4657", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "count": "1 through 10" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 109.93, "10th_percentile": 3.5, "90th_percentile": 109.93, "count": "14" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1631.89, "10th_percentile": 301.2, "90th_percentile": 2214.22, "count": "11" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 55.75, "10th_percentile": 17.68, "90th_percentile": 55.75, "count": "36" } ] } ] }, { "description": "Hc (Sup Shell A4559) Coupling Gel Or Paste", "code_information": [ { "code": "A4559", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 6.18, "10th_percentile": 6.12, "90th_percentile": 7.08, "count": "27" } ] } ] }, { "description": "Hc (Sup Shell A4911) Drain Bag/Bottle", "code_information": [ { "code": "A4911", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 15.93, "10th_percentile": 15.93, "90th_percentile": 16.47, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4648) Implantable Tissue Marker - A4648 - 27800001", "code_information": [ { "code": "A4648", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 645.3, "10th_percentile": 645.3, "90th_percentile": 645.3, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4648) Implantable Tissue Marker - A4648 - 27800080", "code_information": [ { "code": "A4648", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 645.3, "10th_percentile": 645.3, "90th_percentile": 645.3, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6257) Transparent Film <= 16 Sq In - A6257 - 27200146", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 2039.4, "10th_percentile": 2039.4, "90th_percentile": 2039.4, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 1.78, "10th_percentile": 1.78, "90th_percentile": 1.78, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6402) Sterile Gauze <= 16 Sq In - A6402 - RU272059", "code_information": [ { "code": "A6402", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 6.0, "count": "1 through 10" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 3.5, "10th_percentile": 3.5, "90th_percentile": 3.5, "count": "1 through 10" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 107.4, "10th_percentile": 107.4, "90th_percentile": 107.4, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 1.78, "10th_percentile": 1.78, "90th_percentile": 12.43, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6258) Transparent Film >16<=48 In", "code_information": [ { "code": "A6258", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 6.28, "10th_percentile": 6.28, "90th_percentile": 6.28, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6443) Conform Band N/S W>=3<5/Yd", "code_information": [ { "code": "A6443", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 3.5, "10th_percentile": 3.5, "90th_percentile": 7.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.2, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 2.96, "10th_percentile": 2.88, "90th_percentile": 20.16, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6402) Sterile Gauze <= 16 Sq In - A6402 - 27200152", "code_information": [ { "code": "A6402", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 6.0, "count": "1 through 10" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 3.5, "10th_percentile": 3.5, "90th_percentile": 3.5, "count": "1 through 10" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 107.4, "10th_percentile": 107.4, "90th_percentile": 107.4, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 1.78, "10th_percentile": 1.78, "90th_percentile": 12.43, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6452) High Compres Band W>=3<5Yd - A6452 - 27100027", "code_information": [ { "code": "A6452", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 5.78, "10th_percentile": 5.78, "90th_percentile": 5.78, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6257) Transparent Film <= 16 Sq In - A6257 - RU272058", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 2039.4, "10th_percentile": 2039.4, "90th_percentile": 2039.4, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 1.78, "10th_percentile": 1.78, "90th_percentile": 1.78, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6454) Self-Adher Band W>=3 <5/Yd - A6454 - 27100097", "code_information": [ { "code": "A6454", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.2, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6451) Mod Compres Band W>=3<5/Yd", "code_information": [ { "code": "A6451", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.2, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 3.29, "10th_percentile": 2.96, "90th_percentile": 27.79, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6450) Lt Compres Band >=5/Yd - A6450 - 27090040", "code_information": [ { "code": "A6450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.0, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 15.91, "10th_percentile": 15.91, "90th_percentile": 15.91, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.2, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 15.19, "10th_percentile": 15.19, "90th_percentile": 115.29, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6454) Self-Adher Band W>=3 <5/Yd - A6454 - 27100029", "code_information": [ { "code": "A6454", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.2, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6531) Compression Stocking Bk30-40", "code_information": [ { "code": "A6531", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 61.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.0, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 130.06, "10th_percentile": 130.06, "90th_percentile": 130.06, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.2, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 99.66, "10th_percentile": 64.29, "90th_percentile": 99.66, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1729) Catheter Drainage", "code_information": [ { "code": "C1729", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 66.87, "10th_percentile": 66.87, "90th_percentile": 66.87, "count": "19" } ] } ] }, { "description": "Hc (Sup Shell A6450) Lt Compres Band >=5/Yd - A6450 - 27100026", "code_information": [ { "code": "A6450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.0, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 15.91, "10th_percentile": 15.91, "90th_percentile": 15.91, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.2, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 15.19, "10th_percentile": 15.19, "90th_percentile": 115.29, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6452) High Compres Band W>=3<5Yd - A6452 - 27100095", "code_information": [ { "code": "A6452", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 5.78, "10th_percentile": 5.78, "90th_percentile": 5.78, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1725) Catheter Trnslum Angplsty Non-Laser", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 4662.0, "10th_percentile": 4662.0, "90th_percentile": 9071.44, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 7224.39, "10th_percentile": 826.44, "90th_percentile": 16165.07, "count": "17" } ] } ] }, { "description": "Hc (Sup Shell C1760) Closure Device Vascular", "code_information": [ { "code": "C1760", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 2275.0, "10th_percentile": 2275.0, "90th_percentile": 2275.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.0, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 651.2, "10th_percentile": 651.2, "90th_percentile": 868.7, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.2, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1924.0, "10th_percentile": 1777.78, "90th_percentile": 50000.0, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1755) Catheter Intraspinal", "code_information": [ { "code": "C1755", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 115.65, "10th_percentile": 115.65, "90th_percentile": 115.65, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1757) Catheter Thrombectomy/Embolectomy", "code_information": [ { "code": "C1757", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 1020.18, "10th_percentile": 1020.18, "90th_percentile": 1020.18, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1713) Anchr/Screw Oppos Bn-Bn/Sft Tiss-Bn", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 5637.45, "10th_percentile": 5637.45, "90th_percentile": 9282.75, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.0, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 44081.95, "10th_percentile": 44081.95, "90th_percentile": 44081.95, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.2, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 10046.24, "10th_percentile": 1633.32, "90th_percentile": 30985.66, "count": "13" } ] } ] }, { "description": "Hc (Sup Shell C1764) Event Recorder, Cardiac", "code_information": [ { "code": "C1764", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.2, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 25160.0, "10th_percentile": 25160.0, "90th_percentile": 26640.0, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1724) Cath Trnslum Atherect Rotational", "code_information": [ { "code": "C1724", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 8272.07, "10th_percentile": 8272.07, "90th_percentile": 8272.07, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1781) Mesh", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.0, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 3522.32, "10th_percentile": 3522.32, "90th_percentile": 4737.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.2, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 2881.38, "10th_percentile": 1021.62, "90th_percentile": 3133.04, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1769) Guide Wire", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 1615.61, "10th_percentile": 1615.61, "90th_percentile": 3664.57, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 1823.32, "10th_percentile": 53.25, "90th_percentile": 2502.33, "count": "29" } ] } ] }, { "description": "Hc (Sup Shell C1751) Cath Infus Insrt Periph Cntrl/Midln", "code_information": [ { "code": "C1751", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 1354.68, "10th_percentile": 461.5, "90th_percentile": 1354.68, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1753) Cath, Intravas Ultrasound", "code_information": [ { "code": "C1753", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 4140.5, "10th_percentile": 4140.5, "90th_percentile": 4140.5, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 2099.83, "10th_percentile": 2099.83, "90th_percentile": 2261.35, "count": "19" } ] } ] }, { "description": "Hc (Sup Shell C1887) Catheter Guiding", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 3220.43, "10th_percentile": 3220.43, "90th_percentile": 3674.21, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 359.88, "10th_percentile": 73.8, "90th_percentile": 1443.91, "count": "28" } ] } ] }, { "description": "Hc (Sup Shell C1758) Catheter Ureteral", "code_information": [ { "code": "C1758", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 734.29, "10th_percentile": 734.29, "90th_percentile": 734.29, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1894) Intrducr/Sheath Not Guid Non-Lasr", "code_information": [ { "code": "C1894", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 251.65, "10th_percentile": 251.65, "90th_percentile": 652.05, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 330.68, "10th_percentile": 170.76, "90th_percentile": 1066.07, "count": "28" } ] } ] }, { "description": "Hc (Sup Shell C1876) Stnt Non-Coated/Non-Covr Deliv Sys", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.2, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 6016.49, "10th_percentile": 6016.49, "90th_percentile": 6016.49, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C2596) Probe, Robotic, Water-Jet", "code_information": [ { "code": "C2596", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 15781.78, "10th_percentile": 15781.78, "90th_percentile": 15781.78, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C2617) Stent Non-Cor Temp W/O Deliv System", "code_information": [ { "code": "C2617", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.2, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 602.86, "10th_percentile": 602.86, "90th_percentile": 602.86, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1884) Embolization Protective System", "code_information": [ { "code": "C1884", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 8156.75, "10th_percentile": 8156.75, "90th_percentile": 8156.75, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4136.64, "10th_percentile": 4136.64, "90th_percentile": 4136.64, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell Q4101) Apligraf Per Sq Cm", "code_information": [ { "code": "Q4101", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.2, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 7548.0, "10th_percentile": 7548.0, "90th_percentile": 7548.0, "count": "1 through 10" } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - 93307 - 48300011", "code_information": [ { "code": "93307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1899.0, "discounted_cash": 266.0, "minimum": 237.3185, "maximum": 1804.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 768.01 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 530.2 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 272.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 280.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 373.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 266.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 284.57, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 237.32, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 362.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 266.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 266.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 510.99 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 414.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 266.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 266.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.29, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - C8923 - 48300011", "code_information": [ { "code": "C8923", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1899.0, "discounted_cash": 877.0, "minimum": 378.85, "maximum": 1804.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 836.65 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 577.58 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 894.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 920.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1227.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 934.96, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 779.72, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 863.52 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 464.91 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 1127.32, "10th_percentile": 1127.32, "90th_percentile": 1127.32, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1510.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc 3D Rendering W/Interp & Postprocess Supervision (76376)", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1077.0, "minimum": 8.6, "maximum": 1023.15, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.05 } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W/O Imaging Guidance", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2414.15, "discounted_cash": 1014.0, "minimum": 517.45, "maximum": 2414.15, "payers_information": [ { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1065.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1420.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1081.72, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 902.11, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 517.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2414.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1035.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 943.66 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 614.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1035.05, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablation 1/> Liver Tumor Perq Cryoablation", "code_information": [ { "code": "47383", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20591.2, "discounted_cash": 11892.0, "minimum": 1423.0, "maximum": 19561.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7588.45 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 5238.68 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12130.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12487.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16650.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12677.87, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 10572.82, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5189.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4632.01 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6315.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12130.8, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acoustic Reflex Testing", "code_information": [ { "code": "92568", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 41.0, "minimum": 30.43, "maximum": 144.9225, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.8 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 43.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 58.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.54, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 37.14, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.98 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 32.14 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Activated Prot C (Apc) Resistnce Assay", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.25, "discounted_cash": 15.0, "minimum": 6.23, "maximum": 29.6875, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.33, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.42 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.85 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.09 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell Q4186) Epifix Per Sq Cm", "code_information": [ { "code": "Q4186", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 3928.32, "10th_percentile": 2447.64, "90th_percentile": 3928.32, "count": "1 through 10" } ] } ] }, { "description": "Hc Acylcarnitines Quant", "code_information": [ { "code": "82017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.55, "discounted_cash": 16.0, "minimum": 12.033, "maximum": 196.2225, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.38 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.36 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.03 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Adenovirus Ag Eia", "code_information": [ { "code": "87301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.93, "discounted_cash": 11.0, "minimum": 9.74, "maximum": 131.9835, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.33 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.04 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.44 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Adenovirus, Antibody", "code_information": [ { "code": "86603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 163.0, "discounted_cash": 12.0, "minimum": 10.48, "maximum": 154.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.7 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.88 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aep Neurodiagnostic Interpretation And Report", "code_information": [ { "code": "92653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1400.3, "discounted_cash": 241.0, "minimum": 214.7646, "maximum": 1330.285, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 487.28 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 336.39 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 253.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 338.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.52, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 214.76, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 316.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.41, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aerosol Inhalation Treat For Pneum Carinii", "code_information": [ { "code": "94642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 747.3, "discounted_cash": 244.0, "minimum": 21.95, "maximum": 709.935, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 275.39 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.12 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 249.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 257.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 342.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 261.16, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 217.8, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.34 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 85.23 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.89, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Qualit,Multi", "code_information": [ { "code": "86005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.25, "discounted_cash": 7.0, "minimum": 6.03, "maximum": 28.7375, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.2 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.49 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% 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": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 8.98 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell Q4121) Theraskin", "code_information": [ { "code": "Q4121", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.2, "standard_charge_algorithm": "Not To Exceed $50000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 6910.43, "10th_percentile": 2493.21, "90th_percentile": 7111.03, "count": "22" } ] } ] }, { "description": "Hc 2D Tee W Or W/O Fol W/Con,In", "code_information": [ { "code": "C8925", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3814.4, "discounted_cash": 877.0, "minimum": 672.07, "maximum": 3623.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1236.35 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 853.52 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 894.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 920.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1227.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 934.96, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 779.72, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 1354.11, "10th_percentile": 1354.11, "90th_percentile": 1354.11, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1066.67 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 672.07 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 969.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Specific Igg", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.4, "discounted_cash": 7.0, "minimum": 5.55, "maximum": 94.43, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.01 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.36 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.02 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abrasion, Single", "code_information": [ { "code": "15786", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 589.15, "discounted_cash": 224.0, "minimum": 59.045, "maximum": 589.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 230.3 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 149.89 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 235.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 314.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.29, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 199.55, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 589.15 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 135.74 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 59.05 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 589.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acid Single Qual", "code_information": [ { "code": "82127", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.7, "discounted_cash": 14.0, "minimum": 11.55, "maximum": 179.265, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.15 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.55 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.12, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 15.61 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acne Surgery Of Skin Abscess", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 589.15, "discounted_cash": 224.0, "minimum": 59.045, "maximum": 589.15, "payers_information": [ { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 235.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 314.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.29, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 199.55, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 589.15 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 59.05 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 589.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 230.3 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 149.89 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, 2-5 Quant", "code_information": [ { "code": "82136", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.55, "discounted_cash": 19.0, "minimum": 12.033, "maximum": 196.2225, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.1 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.97 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.9, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.36 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.03 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acth Stimj Panel 3 Beta-Hydroxydehyd Defncy", "code_information": [ { "code": "80406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1073.5, "discounted_cash": 78.0, "minimum": 63.74, "maximum": 1019.825, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 100.17 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.74 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 79.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 82.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 109.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.43, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.91 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 85.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 78.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.83, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analysis, Nerve", "code_information": [ { "code": "88356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 511.0, "discounted_cash": 58.0, "minimum": 40.53, "maximum": 485.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.69 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.53 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 59.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 61.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.15, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 51.83, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 46.51 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 49.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.47, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acth Stimulation Panel", "code_information": [ { "code": "80400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310.73, "discounted_cash": 32.0, "minimum": 26.57, "maximum": 295.1935, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.75 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.57 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 34.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 45.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.77, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 36.73 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 32.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.27, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Androstanediol Glucuronide", "code_information": [ { "code": "82154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 313.92, "discounted_cash": 28.0, "minimum": 23.48, "maximum": 298.224, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.9 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 40.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.73, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.76 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 32.47 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.41, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Actigraphy Testing, 3-14 Day", "code_information": [ { "code": "95803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 455.9, "discounted_cash": 66.0, "minimum": 52.185, "maximum": 455.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.01 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 67.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 69.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 92.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 58.67, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 52.19 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 455.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 455.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.32, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extermity Bilat", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15537.0, "discounted_cash": 3532.0, "minimum": 242.0, "maximum": 14760.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3709.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4945.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3765.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3140.53, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 1378.91, "10th_percentile": 1378.91, "90th_percentile": 2757.82, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2780.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3977.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2480.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1265.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abl1 Gene Analysis Kinase Domain Variants", "code_information": [ { "code": "81170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 962.28, "discounted_cash": 300.0, "minimum": 191.97, "maximum": 914.166, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 384.0 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.33 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 315.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 420.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 319.8, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "A Indicator - 85.80% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 394.04 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 300.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Actin Smooth Muscle Antibody Each", "code_information": [ { "code": "86015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.45, "discounted_cash": 12.0, "minimum": 5.28, "maximum": 25.1275, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.39 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.85, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 9.39, "10th_percentile": 9.39, "90th_percentile": 9.39, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Bilat Nonselec", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3542.0, "discounted_cash": 3532.0, "minimum": 242.0, "maximum": 3542.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3542.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3542.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3542.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3542.0, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3140.53, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 971.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1692.58 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 823.28 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 539.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3542.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate Av Node Function", "code_information": [ { "code": "93650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23489.8, "discounted_cash": 8726.0, "minimum": 1423.0, "maximum": 22315.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8726.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9181.92 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5976.14 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8901.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 9162.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12217.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8726.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9302.42, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 7757.83, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8726.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4637.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8726.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8726.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8726.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 8726.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4994.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2819.05 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8726.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 8726.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6315.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8726.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8726.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8901.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Hep B Vac - G0010 - 77100010 - 77100010", "code_information": [ { "code": "G0010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.55, "discounted_cash": 52.0, "minimum": 36.36, "maximum": 200.9725, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.82 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 55.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 73.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.84, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 46.57, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.45 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 51.16 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 36.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.43, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Unilat Select", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4297.0, "discounted_cash": 3532.0, "minimum": 242.0, "maximum": 4297.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3709.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4297.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3765.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3140.53, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2780.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3977.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2480.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 539.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate Renaltumor Cryo, Unilat Perq", "code_information": [ { "code": "50593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20591.2, "discounted_cash": 11892.0, "minimum": 1423.0, "maximum": 19561.64, "payers_information": [ { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4632.01 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2272.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6315.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12130.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8048.85 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 5238.68 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12130.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12487.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16650.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12677.87, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 10572.82, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4370.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11892.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ag Detection Polyval If", "code_information": [ { "code": "87300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.93, "discounted_cash": 11.0, "minimum": 9.74, "maximum": 131.9835, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.33 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.04 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.44 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Spinal Selectv", "code_information": [ { "code": "75705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13594.2, "discounted_cash": 6225.0, "minimum": 242.0, "maximum": 12914.49, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6350.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6536.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8715.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6636.59, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5534.64, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2780.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6156.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2709.62 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6350.2, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate/ Reconstuct Atria, W Othr Proced Limitd", "code_information": [ { "code": "33257", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74446.9, "minimum": 1045.331, "maximum": 70724.555, "payers_information": [ { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9044.52 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 8591.39 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5522.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2716.0 } ] } ] }, { "description": "Hc Agent Nos Assay W/Optic", "code_information": [ { "code": "87899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 16.0, "minimum": 12.75, "maximum": 171.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 108.0, "10th_percentile": 108.0, "90th_percentile": 108.0, "count": "1 through 10" }, { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.57 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.09 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.04 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angiography Iliac During Card Cath - 75710 - 32300016", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4603.0, "discounted_cash": 3532.0, "minimum": 242.0, "maximum": 14760.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3709.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4603.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3765.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3140.53, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 2757.82, "10th_percentile": 1378.91, "90th_percentile": 2757.82, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2780.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3977.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2480.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1265.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablation Bone Tumor W/ Img Gdn When Prfmd", "code_information": [ { "code": "20983", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11978.0, "discounted_cash": 8118.0, "minimum": 1423.0, "maximum": 11379.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8048.85 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 5238.68 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8280.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 8524.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11365.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 7217.29, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4767.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6315.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8118.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8280.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Recombinant/Purified Compnt Ea", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.65, "discounted_cash": 17.0, "minimum": 7.5, "maximum": 85.1675, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.61 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.11, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% 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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.09 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angiotensin I Enzyme Test", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.0, "discounted_cash": 14.0, "minimum": 11.89, "maximum": 117.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 74.4, "10th_percentile": 74.4, "90th_percentile": 74.4, "count": "1 through 10" }, { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.69 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.89 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 44.02, "10th_percentile": 44.02, "90th_percentile": 44.02, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.68 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.44 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholine Receptor Binding Antibody", "code_information": [ { "code": "86041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.43, "discounted_cash": 18.0, "minimum": 14.38, "maximum": 137.2085, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "percent of total billed charges", "standard_charge_percentage": 11.5, "median_amount": 23.55, "10th_percentile": 23.55, "90th_percentile": 23.55, "count": "1 through 10" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein L3", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.9, "discounted_cash": 64.0, "minimum": 52.46, "maximum": 499.605, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82.44 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.46 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 65.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 123.66 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.45 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 72.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.7, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angrph Cath F-Up Std Tcat Othr Than Thrombylsis", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4988.0, "discounted_cash": 3532.0, "minimum": 105.26, "maximum": 4945.724, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3709.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4945.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3765.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3140.53, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1567.61 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 404.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 131.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholn Rcptr Modlg Antb", "code_information": [ { "code": "86043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.44, "discounted_cash": 12.0, "minimum": 9.41, "maximum": 137.218, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "percent of total billed charges", "standard_charge_percentage": 11.5, "median_amount": 15.42, "10th_percentile": 15.42, "90th_percentile": 15.42, "count": "1 through 10" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.85, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, 6+ Quant", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.0, "discounted_cash": 16.0, "minimum": 12.033, "maximum": 68.4, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.38 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.36 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.03 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Anoscopy W Biopsy Sing/Mult", "code_information": [ { "code": "46606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8307.5, "discounted_cash": 1338.0, "minimum": 519.96, "maximum": 7892.125, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 3247.31 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2113.55 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1405.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1874.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1427.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 527.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acth Stimulation Panel 21 Hydroxylase Deficiency", "code_information": [ { "code": "80402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1192.8, "discounted_cash": 86.0, "minimum": 70.83, "maximum": 1133.16, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 97.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 86.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.31 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.83 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 88.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 91.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 121.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.7, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amniocentesis,Ther Amniotic Fluid Reduct", "code_information": [ { "code": "59001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1254.5, "discounted_cash": 340.0, "minimum": 290.0, "maximum": 1254.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 490.37 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 319.16 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 347.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 357.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 477.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 340.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 363.43, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 303.09, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1254.5 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 576.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 340.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 340.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 340.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1254.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 340.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.75, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens, Mlc, Each", "code_information": [ { "code": "87187", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.1, "discounted_cash": 40.0, "minimum": 11.02, "maximum": 147.345, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.42 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.72 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 56.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.77 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.97, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Activity Therapy 45Min Or More, Mentl Disabl Php", "code_information": [ { "code": "G0176", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 370.0, "minimum": 73.82, "maximum": 351.5, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 251.24 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 76.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amniotic Fluid Scan", "code_information": [ { "code": "82143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.01, "discounted_cash": 9.0, "minimum": 7.31, "maximum": 106.4095, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.97 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.62 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.28 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.74 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.54, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Agar Diffusn,Ea", "code_information": [ { "code": "87181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.05, "discounted_cash": 4.0, "minimum": 3.88, "maximum": 92.1975, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.08 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.88 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.11 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.35 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Adjacent Tissue Trns/Reargmt F/C/C/M/N/A/G/H/F 10Sqcm/&Lt", "code_information": [ { "code": "14040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2308.0, "minimum": 939.63, "maximum": 4709.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2758.13 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1795.15 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2354.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2423.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3231.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2460.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2052.21, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1501.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4709.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2354.62, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amputation Of Finger/Thumb", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7276.3, "discounted_cash": 3660.0, "minimum": 1045.331, "maximum": 6912.485, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2844.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1851.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3843.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5125.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3902.4, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3254.44, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1561.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3734.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antidepressants Tricyclic & Cyclicals 6/More - 80337 - 30100422", "code_information": [ { "code": "80337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "minimum": 9.98, "maximum": 47.5, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.03 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Influenza Virus Vac - G0008 - 77100008 - 77100008", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 265.0, "discounted_cash": 52.0, "minimum": 31.7, "maximum": 251.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 55.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 73.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.84, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 46.57, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.45 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 32.24 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 31.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.43, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Adrenal Bilat Select", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13594.2, "discounted_cash": 3532.0, "minimum": 242.0, "maximum": 12914.49, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3709.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4945.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3765.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3140.53, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2780.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3977.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2480.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antinomyces Antibody", "code_information": [ { "code": "86602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.35, "discounted_cash": 10.0, "minimum": 8.3, "maximum": 144.7325, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.03 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.3 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.52 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Agglutinins; Febrile", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.0, "discounted_cash": 6.0, "minimum": 5.68, "maximum": 81.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.68 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.44, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.32 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.86 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Visceral Selectv/Subselec", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 6225.0, "minimum": 242.0, "maximum": 12473.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5009.84 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3458.54 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6350.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6536.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8715.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6636.59, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5534.64, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2780.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6156.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2709.62 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1265.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6350.2, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aortic Dys/Dilat Genom Seq Ana", "code_information": [ { "code": "81410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13750.0, "discounted_cash": 504.0, "minimum": 393.78, "maximum": 13062.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 645.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 410.48 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 514.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 529.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 705.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 504.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 393.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.08, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Airway Resistance By Impulse Oscillometry", "code_information": [ { "code": "94728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1101.75, "discounted_cash": 143.0, "minimum": 86.653, "maximum": 1046.6625, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 406.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.3 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 146.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 151.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 201.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.46, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 127.98, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 336.74 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 86.65 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.84, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antegrade Urography Radiological Supvj & Interpj", "code_information": [ { "code": "74425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1554.0, "discounted_cash": 390.0, "minimum": 158.46, "maximum": 1476.3, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 158.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 409.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 546.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 416.09, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 347.0, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 247.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 566.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 255.79 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm Ea Ad 25Qsqcm", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 507.5, "minimum": 112.05, "maximum": 507.5, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 507.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.05 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 507.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 } ] } ] }, { "description": "Hc Albumin Ischemia Modified", "code_information": [ { "code": "82045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.33, "discounted_cash": 33.0, "minimum": 27.64, "maximum": 307.1635, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.44 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.64 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 34.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 35.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 47.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.18, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.16 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.04 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 38.22 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 33.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.62, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Mic,Each", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.0, "discounted_cash": 8.0, "minimum": 7.04, "maximum": 143.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 90.6, "10th_percentile": 90.6, "90th_percentile": 90.6, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.07 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.04 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 105.7, "10th_percentile": 105.7, "90th_percentile": 105.7, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 53.61, "10th_percentile": 53.61, "90th_percentile": 53.61, "count": "38" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.59 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 107.81, "10th_percentile": 107.81, "90th_percentile": 107.81, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Forearm Splint", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 455.9, "discounted_cash": 148.0, "minimum": 90.95, "maximum": 455.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 178.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 115.99 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 151.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 156.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 208.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.68, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 132.34, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 455.9 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 97.86 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 455.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.84, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Pheno", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.0, "discounted_cash": 14.0, "minimum": 11.78, "maximum": 71.25, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.51 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.78 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 26.63, "10th_percentile": 26.63, "90th_percentile": 26.63, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.76 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.46 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.28 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Detection Nos If", "code_information": [ { "code": "87299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.5, "discounted_cash": 16.0, "minimum": 12.75, "maximum": 76.475, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.61 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.14 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.42, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Leg Cast", "code_information": [ { "code": "29345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1047.0, "discounted_cash": 312.0, "minimum": 208.88, "maximum": 1047.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 406.29 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 264.45 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 319.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 328.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 438.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.57, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 278.19, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1047.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 367.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 220.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1047.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.18, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc 3D Rendering W/Interp&Postproc Diff Work Statio", "code_information": [ { "code": "76377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 973.0, "minimum": 98.78, "maximum": 924.35, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 123.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 98.78 } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Total", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.0, "discounted_cash": 13.0, "minimum": 10.94, "maximum": 92.15, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.94 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.33, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 34.44, "10th_percentile": 34.44, "90th_percentile": 34.44, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.79 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 15.13 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class I & Class Ii Antigens Qual", "code_information": [ { "code": "86828", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1050.0, "discounted_cash": 64.0, "minimum": 42.08, "maximum": 997.5, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82.16 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 65.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 67.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 89.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.43, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.54 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.31 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 44.56 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 64.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.47, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Short Leg Cast,Walker", "code_information": [ { "code": "29425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 653.0, "discounted_cash": 312.0, "minimum": 130.27, "maximum": 653.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 406.29 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 264.45 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 319.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 328.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 438.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.57, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 278.19, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 653.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 367.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 220.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 653.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.18, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W Imaging Guidance", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2414.15, "discounted_cash": 1014.0, "minimum": 481.62, "maximum": 2414.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 943.66 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 614.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1035.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1065.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1420.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1081.72, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 902.11, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 517.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2414.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1035.05, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein, Serum", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.0, "discounted_cash": 16.0, "minimum": 13.66, "maximum": 105.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 66.6, "10th_percentile": 66.6, "90th_percentile": 66.6, "count": "1 through 10" }, { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.47 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.66 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 39.41, "10th_percentile": 39.41, "90th_percentile": 39.41, "count": "14" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.2 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 16.77, "10th_percentile": 16.77, "90th_percentile": 16.77, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.21 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 18.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class Ii High Definition Panel Qual", "code_information": [ { "code": "86833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 846.0, "discounted_cash": 325.0, "minimum": 122.64, "maximum": 803.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 417.02 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 265.35 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 332.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 342.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 456.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 347.3, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 427.93 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 128.94 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 325.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 122.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 332.32, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquaporin-4 Antibody Elisa", "code_information": [ { "code": "86051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1500.0, "discounted_cash": 11.0, "minimum": 9.01, "maximum": 1425.0, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.39 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate L/R Atrial Fibril W Isolated Pulm Vein", "code_information": [ { "code": "93657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20364.0, "minimum": 290.0, "maximum": 19345.8, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3774.0 } ] } ] }, { "description": "Hc Ambl Bld Press W/Tape/Disk 24/>Hr Alys W/Reprt", "code_information": [ { "code": "93788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 878.0, "discounted_cash": 148.0, "minimum": 68.53, "maximum": 834.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.01 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 151.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 156.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 208.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.68, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 132.34, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 68.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.84, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antidepressants Tricyclic & Cyclicals 6/More - G0480 - 30100422", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Antihuman Globulin Dir Ea Antiserum", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 279.7, "discounted_cash": 66.0, "minimum": 5.39, "maximum": 295.3075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.24 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.33 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 67.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 69.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 92.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 58.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 110.35, "10th_percentile": 110.35, "90th_percentile": 331.06, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.13 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.32, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholinesterase Assay", "code_information": [ { "code": "82013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.26, "discounted_cash": 12.0, "minimum": 7.43, "maximum": 35.397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.73 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.11 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.58 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, Multiple Qual", "code_information": [ { "code": "82128", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.87, "discounted_cash": 13.0, "minimum": 3.76, "maximum": 18.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.75 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.79, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.87 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 15.61 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.15, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antiepileptics Not Otherwise Specified 1-3 - 80339 - 30100444", "code_information": [ { "code": "80339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.0, "minimum": 6.01, "maximum": 237.5, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrocnt Aspir&/Inj Small Jt/Bursaw/Us Rec Rprt", "code_information": [ { "code": "20604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1334.15, "discounted_cash": 343.0, "minimum": 263.0, "maximum": 1334.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 437.32 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 284.64 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 350.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 360.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 480.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 366.09, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 305.3, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1334.15 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 267.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 263.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1334.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 350.29, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholn Rcptr Blckg Antb", "code_information": [ { "code": "86042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.44, "discounted_cash": 18.0, "minimum": 14.38, "maximum": 137.218, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "percent of total billed charges", "standard_charge_percentage": 11.5, "median_amount": 23.55, "10th_percentile": 23.55, "90th_percentile": 23.55, "count": "1 through 10" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antiepileptics Not Otherwise Specified 1-3 - G0480 - 30100444", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.0, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Elbow", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3517.1, "discounted_cash": 390.0, "minimum": 216.54, "maximum": 3341.245, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 409.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 546.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 416.09, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 347.0, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 377.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 651.19 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 330.34 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acoustic Immitance Testing", "code_information": [ { "code": "92570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 648.75, "discounted_cash": 143.0, "minimum": 44.17, "maximum": 616.3125, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 239.08 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.04 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 146.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 151.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 201.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.46, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 127.98, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 203.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 74.95 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.84, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Adrenal Unilat Select", "code_information": [ { "code": "75731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4305.0, "discounted_cash": 3532.0, "minimum": 242.0, "maximum": 4305.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3709.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4305.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3765.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3140.53, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2780.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2140.69 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2480.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1265.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Dir Ea Antiserum", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310.85, "discounted_cash": 66.0, "minimum": 5.39, "maximum": 295.3075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.24 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.33 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 67.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 69.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 92.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 58.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 110.35, "10th_percentile": 110.35, "90th_percentile": 331.06, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.13 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.32, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Hip", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1918.05, "discounted_cash": 390.0, "minimum": 216.54, "maximum": 1822.1475, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 409.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 546.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 416.09, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 347.0, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 377.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 651.19 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 330.34 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Pneumococcal Vac - G0009 - 77100009 - 77100009", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 265.0, "discounted_cash": 52.0, "minimum": 30.3, "maximum": 251.75, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.45 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 51.16 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 30.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 55.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 73.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.84, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 46.57, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortogram Abd Serial", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15537.0, "discounted_cash": 3532.0, "minimum": 242.0, "maximum": 14760.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3709.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4945.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3765.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3140.53, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 2757.82, "10th_percentile": 2757.82, "90th_percentile": 5515.64, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2780.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3977.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2480.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1265.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Indirect Ea Antibody Titer", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.0, "discounted_cash": 190.0, "minimum": 5.18, "maximum": 485.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 86.0 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.0 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 30.53, "10th_percentile": 30.53, "90th_percentile": 181.41, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Knee Joint", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1102.0, "discounted_cash": 390.0, "minimum": 216.54, "maximum": 1046.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 409.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 546.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 416.09, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 347.0, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 377.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 651.19 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 330.34 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aep Hearing Status Deter Broadband Stimuli I&R", "code_information": [ { "code": "92651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 810.0, "discounted_cash": 241.0, "minimum": 161.6, "maximum": 769.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 257.14 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.52 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 253.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 338.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.52, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 214.76, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.41, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Intern Mammary", "code_information": [ { "code": "75756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4988.0, "discounted_cash": 3532.0, "minimum": 242.0, "maximum": 4945.724, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3709.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4945.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3765.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3140.53, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 971.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3503.57 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 823.28 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 539.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antinuclear Antibodies", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.0, "discounted_cash": 12.0, "minimum": 9.86, "maximum": 127.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 12.09, "10th_percentile": 12.09, "90th_percentile": 80.4, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.48 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.86 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 93.8, "10th_percentile": 93.8, "90th_percentile": 93.8, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 47.57, "10th_percentile": 47.57, "90th_percentile": 47.57, "count": "30" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.21 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 12.09, "10th_percentile": 12.09, "90th_percentile": 12.09, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspergillus Antibody", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 59.0, "discounted_cash": 15.0, "minimum": 11.77, "maximum": 56.05, "payers_information": [ { "payer_name": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.42 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 15.05, "10th_percentile": 15.05, "90th_percentile": 30.1, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.04, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 20.95, "10th_percentile": 20.95, "90th_percentile": 41.89, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aep Scr Auditory Potential W/Stimuli Auto Alys", "code_information": [ { "code": "92650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.6, "minimum": 25.81, "maximum": 259.92, "payers_information": [ { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.42 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pelvis", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 6225.0, "minimum": 242.0, "maximum": 12473.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6350.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6536.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8715.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6636.59, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5534.64, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2780.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6156.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2480.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1265.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6350.2, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antithrombin Iii Test,Antigen", "code_information": [ { "code": "85301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.71, "discounted_cash": 10.0, "minimum": 2.93, "maximum": 14.71, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.84 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.81 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.52, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.0, "discounted_cash": 5.0, "minimum": 4.23, "maximum": 58.9, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.63 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 22.01, "10th_percentile": 22.01, "90th_percentile": 22.01, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.39 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.82 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ag Detect Nos, Eia, Mult Step", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.0, "discounted_cash": 11.0, "minimum": 9.74, "maximum": 121.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 76.8, "10th_percentile": 76.8, "90th_percentile": 76.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.33 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 45.44, "10th_percentile": 45.44, "90th_percentile": 45.44, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.04 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.44 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Bilat Select", "code_information": [ { "code": "75743", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5149.0, "discounted_cash": 3532.0, "minimum": 242.0, "maximum": 4945.724, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3709.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4945.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3765.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3140.53, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2780.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3977.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2480.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1265.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7056.05, "discounted_cash": 826.0, "minimum": 256.431, "maximum": 6703.2475, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2758.13 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1795.15 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 843.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 868.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1157.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 881.46, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 735.11, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 256.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 843.43, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Anti-Mullerian Horm", "code_information": [ { "code": "82166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.0, "discounted_cash": 38.0, "minimum": 24.15, "maximum": 199.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 126.0, "10th_percentile": 126.0, "90th_percentile": 126.0, "count": "1 through 10" }, { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "percent of total billed charges", "standard_charge_percentage": 11.5, "median_amount": 49.43, "10th_percentile": 49.43, "90th_percentile": 49.43, "count": "1 through 10" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 63.0, "10th_percentile": 63.0, "90th_percentile": 63.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.17, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 74.55, "10th_percentile": 74.55, "90th_percentile": 74.55, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.0, "median_amount": 140.7, "10th_percentile": 140.7, "90th_percentile": 140.7, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 38.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.39, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ag Detect Nos, Eia, Single", "code_information": [ { "code": "87450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.77, "minimum": 8.61, "maximum": 136.5815, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.55 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 8.61 } ] } ] }, { "description": "Hc Angio Retro Brachial Angio", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15537.0, "discounted_cash": 3532.0, "minimum": 242.0, "maximum": 14760.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3709.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4945.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3765.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3140.53, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 2757.82, "10th_percentile": 1378.91, "90th_percentile": 2757.82, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2780.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3977.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2480.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1265.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm Ea Ad 25Cm", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 670.4, "minimum": 112.05, "maximum": 670.4, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 670.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.05 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 670.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 } ] } ] }, { "description": "Hc Assay C-D Transfer Measure", "code_information": [ { "code": "82373", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.22, "discounted_cash": 18.0, "minimum": 14.71, "maximum": 210.159, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.25, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 20.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.42, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Airway Inhalation Treatment", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1035.63, "discounted_cash": 244.0, "minimum": 37.81, "maximum": 983.8485, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 621.38, "10th_percentile": 621.38, "90th_percentile": 621.38, "count": "14" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 275.39 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.12 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 249.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 257.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 342.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 724.94, "10th_percentile": 724.94, "90th_percentile": 724.94, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 261.16, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 217.8, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 367.65, "10th_percentile": 367.65, "90th_percentile": 367.65, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 222.7, "10th_percentile": 222.7, "90th_percentile": 222.7, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.21 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 42.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 417.6, "10th_percentile": 252.74, "90th_percentile": 484.03, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 244.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.89, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class I High Definition Panel Qual", "code_information": [ { "code": "86832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 884.17, "discounted_cash": 323.0, "minimum": 134.9, "maximum": 839.9615, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 414.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.69 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 330.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 339.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 453.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 345.12, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 425.23 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 141.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 323.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 330.23, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm 1St 100Sqcm", "code_information": [ { "code": "15273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10687.5, "discounted_cash": 2308.0, "minimum": 256.431, "maximum": 10153.125, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4177.6 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2719.03 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2354.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2423.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3231.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2460.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2052.21, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 463.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 256.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5854.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2354.62, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Carbamazepine Free", "code_information": [ { "code": "80157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.4, "discounted_cash": 13.0, "minimum": 10.8, "maximum": 171.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.96 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.48 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 14.93 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alkaloids Not Otherwise Specified - 80323 - 30080323", "code_information": [ { "code": "80323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.29, "minimum": 11.11, "maximum": 271.6525, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.92 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class Ii Phenotype Panel Qual", "code_information": [ { "code": "86831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 605.0, "discounted_cash": 81.0, "minimum": 66.69, "maximum": 574.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 104.81 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 83.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 85.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.28, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.22 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 77.36 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.52, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm Ea Add 100Sqcm", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1265.15, "minimum": 290.0, "maximum": 1265.15, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1265.15 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.04 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1265.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 } ] } ] }, { "description": "Hc Assay L/S Ratio", "code_information": [ { "code": "83661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 59.8, "discounted_cash": 21.0, "minimum": 11.93, "maximum": 56.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.15 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.91 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 23.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.65 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 24.75 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.43, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alkaloids Not Otherwise Specified - G0480 - 30080323", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.29, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antineutrophil Cytoplasmic Antb Titer Ea Antb", "code_information": [ { "code": "86037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.05, "discounted_cash": 12.0, "minimum": 7.39, "maximum": 35.1975, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 12.05, "10th_percentile": 12.05, "90th_percentile": 24.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.42 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.85, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 13.15, "10th_percentile": 12.85, "90th_percentile": 26.31, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.0, "median_amount": 74.47, "10th_percentile": 74.47, "90th_percentile": 74.47, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7056.05, "discounted_cash": 826.0, "minimum": 256.431, "maximum": 6703.2475, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2758.13 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1795.15 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 843.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 868.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1157.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 881.46, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 735.11, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 256.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 826.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 843.43, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Lipoprotein Pla2", "code_information": [ { "code": "83698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.33, "discounted_cash": 46.0, "minimum": 36.09, "maximum": 307.1635, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.28 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.72 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 47.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 48.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 64.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.37, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.82 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 38.22 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 46.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.24, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Quant,Each", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.0, "discounted_cash": 5.0, "minimum": 4.25, "maximum": 61.75, "payers_information": [ { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 92.3, "10th_percentile": 23.08, "90th_percentile": 576.88, "count": "19" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.02 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 39.0, "10th_percentile": 39.0, "90th_percentile": 39.0, "count": "1 through 10" }, { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.68 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.25 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antithrombin Iii Test,Activ", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.0, "discounted_cash": 11.0, "minimum": 9.65, "maximum": 238.45, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.17 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.65 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 89.11, "10th_percentile": 12.63, "90th_percentile": 89.11, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.75 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.21 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 13.35 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Appl Multlay Comprs Arm/Hand", "code_information": [ { "code": "29584", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345.0, "discounted_cash": 181.0, "minimum": 59.045, "maximum": 345.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 233.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 151.69 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 185.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 190.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 254.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.8, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 161.62, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 345.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 135.74 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 59.05 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 345.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.44, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Adp & Amp", "code_information": [ { "code": "82030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.88, "discounted_cash": 25.0, "minimum": 21.02, "maximum": 266.836, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.02 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.02 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 36.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.84 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 29.04 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.32, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein; Amniotic", "code_information": [ { "code": "82106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.5, "discounted_cash": 17.0, "minimum": 13.67, "maximum": 65.075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.76 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.85 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.21 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 18.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt >=100Sqcm 1St 100Sqcm", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10687.5, "discounted_cash": 2308.0, "minimum": 256.431, "maximum": 10153.125, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 4177.6 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2719.03 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2354.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2423.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3231.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2460.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2052.21, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 463.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 256.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2308.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2354.62, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Appl On-Body Injector For Timed Subq Injection", "code_information": [ { "code": "96377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.15, "discounted_cash": 52.0, "minimum": 46.5658, "maximum": 238.5925, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78.08 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.9 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 55.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 73.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.84, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 46.57, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.45 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.43, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Alcohol (Ethanol) Breath", "code_information": [ { "code": "82075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.1, "discounted_cash": 30.0, "minimum": 12.81, "maximum": 155.895, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.43 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 13.57 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.6, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, Single Quantitation", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.0, "discounted_cash": 22.0, "minimum": 12.97, "maximum": 61.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.41 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.71 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 32.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.5, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.19 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 18.99 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Arm Splint", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 605.0, "discounted_cash": 181.0, "minimum": 101.93, "maximum": 605.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 233.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 151.69 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 185.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 190.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 254.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.8, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 161.62, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 605.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 205.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 115.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 605.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.44, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Finger Splint Static", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 337.0, "discounted_cash": 148.0, "minimum": 54.537, "maximum": 337.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 109.34 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 71.16 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 151.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 156.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 208.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.68, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 132.34, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 337.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.95 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 54.54 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 337.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.84, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Aldosterone", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 235.0, "discounted_cash": 40.0, "minimum": 33.19, "maximum": 223.25, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.16 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 41.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.23 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 45.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.57, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amniocentesis,Diagnostic", "code_information": [ { "code": "59000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3184.2, "discounted_cash": 1030.0, "minimum": 256.431, "maximum": 3184.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1030.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1244.67 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 810.1 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1051.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1082.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1442.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1030.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1098.51, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 916.11, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1030.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 282.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1030.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1030.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1030.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1030.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 256.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1030.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1030.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3184.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1030.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1030.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.11, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Leg Splint", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 249.0, "discounted_cash": 181.0, "minimum": 49.68, "maximum": 249.0, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 249.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 249.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 149.4, "10th_percentile": 149.4, "90th_percentile": 149.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 233.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 151.69 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 185.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 190.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 249.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.8, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 161.62, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 249.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 205.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 115.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Forearm Splint Static", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 605.0, "discounted_cash": 148.0, "minimum": 97.86, "maximum": 605.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 178.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 115.99 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 151.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 156.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 208.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.68, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 132.34, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 605.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 97.86 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 605.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.84, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amphetamines - G0480 - 30100323", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.35, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analysis, Skeletal Muscle", "code_information": [ { "code": "88355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 511.0, "discounted_cash": 190.0, "minimum": 33.95, "maximum": 485.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 190.92 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.48 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 200.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 266.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 169.45, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 46.51 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Multlay Comprs Lwr Leg", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 430.0, "discounted_cash": 181.0, "minimum": 85.79, "maximum": 430.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 233.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 151.69 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 185.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 190.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 254.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.8, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 161.62, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 430.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 263.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 112.04 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 430.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.44, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Rigid Leg Cast", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 707.0, "discounted_cash": 312.0, "minimum": 141.05, "maximum": 707.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 406.29 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 264.45 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 319.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 328.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 438.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.57, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 278.19, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 707.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 367.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 220.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 707.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.18, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Androsterone", "code_information": [ { "code": "82160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.24, "discounted_cash": 25.0, "minimum": 20.8, "maximum": 258.628, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.7 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.8 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.24, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.54 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 28.15 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.06, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analysis, Tumor", "code_information": [ { "code": "88358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1047.1, "discounted_cash": 190.0, "minimum": 46.508, "maximum": 994.745, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 190.92 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.48 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 200.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 266.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 169.45, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 46.51 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquatic Therapy/Exercises Ea 15 Min", "code_information": [ { "code": "97113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.0, "discounted_cash": 38.0, "minimum": 32.6297, "maximum": 198.0, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 38.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.45 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 39.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 38.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 198.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 168.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 39.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 83.02 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.32 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 39.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 53.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 38.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.54, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 32.63, "additional_payer_notes": "A Indicator - 85.80% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.03, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply/Remove Cranial Fix Dev", "code_information": [ { "code": "20660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 1799.0, "minimum": 256.431, "maximum": 5482.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1799.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2142.96 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1394.77 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1835.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1889.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2518.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1799.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1917.8, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1599.36, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1799.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 577.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1799.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1799.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1799.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1799.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 256.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1799.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1799.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5482.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1799.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1799.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1835.04, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Apolipoprotein", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.0, "discounted_cash": 21.0, "minimum": 13.57, "maximum": 64.6, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.18 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 17.45 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analyze Neurostim,Complx/Prog", "code_information": [ { "code": "95972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 532.2, "discounted_cash": 106.0, "minimum": 94.5629, "maximum": 532.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 196.13 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.4 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 111.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 148.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.39, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 94.56, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.35 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 125.62 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 532.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Antihuman Globulin Indirect Ea Antibody Titer", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 511.0, "discounted_cash": 190.0, "minimum": 5.18, "maximum": 485.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 190.92 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.48 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 200.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 266.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 169.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 30.53, "10th_percentile": 30.53, "90th_percentile": 181.41, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Rbc Antigens", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.02, "discounted_cash": 401.0, "minimum": 3.83, "maximum": 515.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 103.02 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.02 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.84 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Barbiturates - 80345 - 30100326", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.95, "minimum": 6.77, "maximum": 32.2525, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analyze Neurostim,No Reprog", "code_information": [ { "code": "95970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 455.9, "discounted_cash": 148.0, "minimum": 49.119, "maximum": 455.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.01 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 151.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 156.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 208.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.68, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 132.34, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 111.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 49.12 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 455.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 455.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 148.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.84, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Abo", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.0, "discounted_cash": 148.0, "minimum": 2.99, "maximum": 360.715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 227.82, "10th_percentile": 40.8, "90th_percentile": 227.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 68.0 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.0 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 265.79, "10th_percentile": 227.82, "90th_percentile": 265.79, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 134.79, "10th_percentile": 134.79, "90th_percentile": 134.79, "count": "231" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 11.8, "10th_percentile": 11.8, "90th_percentile": 11.8, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Cold Agglutinin Screen", "code_information": [ { "code": "86156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.44, "discounted_cash": 8.0, "minimum": 6.57, "maximum": 103.968, "payers_information": [ { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 8.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.86 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.18 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Pku", "code_information": [ { "code": "84030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21.91, "discounted_cash": 5.0, "minimum": 4.37, "maximum": 20.8145, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.48 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.57 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 6.19 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analyze Neurostim,Simple/Prog", "code_information": [ { "code": "95971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 532.2, "discounted_cash": 106.0, "minimum": 94.5629, "maximum": 532.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 196.13 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.4 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 111.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 148.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.39, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 94.56, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.35 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 125.62 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 532.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 108.5, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Rh Phenotype", "code_information": [ { "code": "86906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 41.0, "minimum": 7.75, "maximum": 144.9225, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.32 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.56 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 43.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 58.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.54, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 37.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.06 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.84 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Antibody Elution", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.0, "discounted_cash": 190.0, "minimum": 23.54, "maximum": 489.345, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.0 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.0 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 30.51 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 118.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cadmium", "code_information": [ { "code": "82300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.0, "discounted_cash": 23.0, "minimum": 19.25, "maximum": 129.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.26 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.25 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.54 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 26.07 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortobifemoral W Cath", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9818.61, "discounted_cash": 3532.0, "minimum": 242.0, "maximum": 9327.6795, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3709.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4945.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3765.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3140.53, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 1742.81, "10th_percentile": 871.4, "90th_percentile": 3485.61, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2780.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3977.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2480.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1265.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Cold Agglutinin, Titer", "code_information": [ { "code": "86157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.0, "discounted_cash": 8.0, "minimum": 2.19, "maximum": 112.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.56 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.07 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Chem Or Drugs", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 66.0, "minimum": 21.924, "maximum": 144.9225, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.32 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.56 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 67.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 69.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 92.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 58.67, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 21.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 33.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 38.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.32, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcitonin", "code_information": [ { "code": "82308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 223.0, "discounted_cash": 26.0, "minimum": 21.82, "maximum": 211.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.29 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.82 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.45 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 30.16 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 26.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortogram Thor Serial", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 6225.0, "minimum": 242.0, "maximum": 12473.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6350.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6536.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8715.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6636.59, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5534.64, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2780.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6156.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2480.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1265.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6225.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6350.2, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Hemolysins & Agglutinins, Incubated", "code_information": [ { "code": "86941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.8, "discounted_cash": 12.0, "minimum": 9.87, "maximum": 156.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 13.64 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Enzym", "code_information": [ { "code": "86971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 190.0, "minimum": 21.924, "maximum": 489.345, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 372.81 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.21 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 200.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 266.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 169.45, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 244.54 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 21.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 100.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Chloramphenicol", "code_information": [ { "code": "82415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.4, "discounted_cash": 12.0, "minimum": 10.32, "maximum": 163.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.55 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 14.27 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortogram Thoracic", "code_information": [ { "code": "75600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13594.2, "discounted_cash": 3532.0, "minimum": 242.0, "maximum": 12914.49, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3709.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4945.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3765.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3140.53, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2780.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3977.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2480.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1265.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Hemolysins/Agglutinins Auto", "code_information": [ { "code": "86940", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.76, "discounted_cash": 8.0, "minimum": 7.14, "maximum": 116.622, "payers_information": [ { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.74 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 9.23 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.23 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.14 } ] } ] }, { "description": "Hc Arterial Line Insertion", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 893.5, "minimum": 268.05, "maximum": 893.5, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 893.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 893.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 } ] } ] }, { "description": "Hc Assay Of Chromium", "code_information": [ { "code": "82495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.0, "discounted_cash": 20.0, "minimum": 16.52, "maximum": 78.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.96 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.52 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.62, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 22.84 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Ea Addnl Selectv Vessel", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2722.0, "minimum": 242.0, "maximum": 2585.9, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 493.98 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 539.31 } ] } ] }, { "description": "Hc Arc Rbc Antibody Identification", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.0, "discounted_cash": 401.0, "minimum": 30.828, "maximum": 994.745, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 132.6, "10th_percentile": 132.6, "90th_percentile": 628.26, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.0 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.0 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 221.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 221.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 221.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 221.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.0, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 221.0, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 371.72, "10th_percentile": 78.46, "90th_percentile": 371.72, "count": "25" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 221.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 221.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 221.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 30.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 221.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 221.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 123.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrocentesis Aspir&/Inj Major Jt/Bursa W/Us", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1544.0, "discounted_cash": 343.0, "minimum": 263.0, "maximum": 1544.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 437.32 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 284.64 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 350.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 360.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 480.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 366.09, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 305.3, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 267.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 263.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1544.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 350.29, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Copper", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.0, "discounted_cash": 12.0, "minimum": 10.1, "maximum": 62.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.88 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.1 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 92.4, "10th_percentile": 92.4, "90th_percentile": 92.4, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 23.43, "10th_percentile": 23.43, "90th_percentile": 23.43, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.13 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 13.97 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extremity Unilat", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15537.0, "discounted_cash": 3532.0, "minimum": 242.0, "maximum": 14760.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 3709.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4945.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3765.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3140.53, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 2757.82, "10th_percentile": 1378.91, "90th_percentile": 2757.82, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2780.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3977.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 2480.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1265.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.31, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment,Serum W Drugs", "code_information": [ { "code": "86975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 499.0, "minimum": 30.43, "maximum": 152.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 152.55 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.55 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 152.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 152.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 152.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.55, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 152.55, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 152.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.06 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 41.87 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 152.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 109.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 52.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.55, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Ankle", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1758.55, "discounted_cash": 390.0, "minimum": 216.54, "maximum": 1670.6225, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 409.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 546.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 416.09, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 347.0, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 377.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 651.19 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 330.34 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Creatine", "code_information": [ { "code": "82540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.0, "discounted_cash": 4.0, "minimum": 3.78, "maximum": 121.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.94 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.78 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angiography Iliac During Card Cath - G0278 - 32300016", "code_information": [ { "code": "G0278", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4603.0, "minimum": 242.0, "maximum": 4372.85, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Den Grad Sep", "code_information": [ { "code": "86972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 190.0, "minimum": 21.924, "maximum": 489.345, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 190.92 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.48 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 200.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 266.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 169.45, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.65 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 21.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 29.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Wrist", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 965.0, "discounted_cash": 390.0, "minimum": 192.52, "maximum": 916.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 409.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 546.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 416.09, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 347.0, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 377.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 527.64 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 330.34 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cryoglobulin", "code_information": [ { "code": "82595", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.0, "discounted_cash": 6.0, "minimum": 5.27, "maximum": 104.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.28 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.29 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Anoscopy W Dilation", "code_information": [ { "code": "46604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8307.5, "discounted_cash": 1338.0, "minimum": 519.96, "maximum": 7892.125, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 3247.31 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 2113.55 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1405.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1874.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1427.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1338.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arterial Cath Prolngd Nfs Ther Chemotx Cutdown", "code_information": [ { "code": "36640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1355.75, "discounted_cash": 3532.0, "minimum": 406.725, "maximum": 1355.75, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1355.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1324.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1355.75 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1355.75 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1355.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 } ] } ] }, { "description": "Hc Ashkenazi Jewish Assoc Dsrdrs Gen Seq Anal 9 Gen", "code_information": [ { "code": "81412", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2100.0, "discounted_cash": 2448.0, "minimum": 418.95, "maximum": 2100.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.0 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1994.25 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "A Indicator - 85.80% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2100.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2100.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 470.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cyclosporine", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.0, "discounted_cash": 18.0, "minimum": 14.7, "maximum": 105.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.1 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.26 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 20.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.41, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Anoscopy W Remove Foreign Body", "code_information": [ { "code": "46608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3763.8, "discounted_cash": 1040.0, "minimum": 519.96, "maximum": 3763.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1471.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 957.56 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1061.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1092.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1456.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1109.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 924.97, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3763.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1040.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1061.27, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrocentesis Aspir&/Inj Interm Jt/Burs W/Us", "code_information": [ { "code": "20606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2535.95, "discounted_cash": 789.0, "minimum": 263.0, "maximum": 2535.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 789.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 437.32 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 284.64 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 805.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 829.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1105.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 789.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 841.87, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 702.09, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 900.26, "10th_percentile": 900.26, "90th_percentile": 900.26, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 789.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 267.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 789.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 789.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 789.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 789.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 263.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 789.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 789.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2535.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 789.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 789.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 805.55, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspergillus Ag Eia", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.0, "discounted_cash": 11.0, "minimum": 9.74, "maximum": 115.9, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.33 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.04 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.44 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Doxepin - G0480 - 30100409", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.81, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antb Severe Aqt Respir Synd Sars-Cov-2 Covid19", "code_information": [ { "code": "86769", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.75, "discounted_cash": 42.0, "minimum": 13.52, "maximum": 64.3625, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.8 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 58.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.91, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "A Indicator - 85.80% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.97, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Shoulder", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1809.24, "discounted_cash": 390.0, "minimum": 216.54, "maximum": 1718.778, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 409.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 546.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 416.09, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 347.0, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 377.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 601.06 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 330.34 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 242.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 390.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay 17-(17-Ks)Ketosteroids", "code_information": [ { "code": "83586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 12.0, "minimum": 10.42, "maximum": 128.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.38 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.75 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 14.42 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estrone", "code_information": [ { "code": "82679", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.0, "discounted_cash": 24.0, "minimum": 20.33, "maximum": 123.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.33 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 26.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 46.15, "10th_percentile": 46.15, "90th_percentile": 46.15, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.47 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 28.11 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Enzyme Detection,Each", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.0, "discounted_cash": 4.0, "minimum": 3.88, "maximum": 45.6, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.08 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.88 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.11 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.35 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Asp & Inj Bone Cyst", "code_information": [ { "code": "20615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 792.0, "minimum": 256.431, "maximum": 4474.405, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1841.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1198.26 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 831.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1109.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 844.56, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 704.33, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 420.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 256.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4082.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Alkal Phosphatase,Heat Stabl W/O Total", "code_information": [ { "code": "84078", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.28, "discounted_cash": 8.0, "minimum": 6.73, "maximum": 113.316, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.57 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.84 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 8.22 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethanol - 80320 - 30100052", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "minimum": 11.11, "maximum": 201.096, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.06 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 21.43, "10th_percentile": 21.43, "90th_percentile": 21.43, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.38 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Treponema Pallidum", "code_information": [ { "code": "86780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20.0, "discounted_cash": 13.0, "minimum": 3.99, "maximum": 20.0, "payers_information": [ { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "A Indicator - 85.80% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 7.1, "10th_percentile": 7.1, "90th_percentile": 7.1, "count": "33" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 13.24, "10th_percentile": 13.24, "90th_percentile": 13.24, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 14.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 12.0, "10th_percentile": 12.0, "90th_percentile": 12.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.95 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.78 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspa Gene", "code_information": [ { "code": "81200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 556.0, "discounted_cash": 47.0, "minimum": 36.92, "maximum": 528.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.48 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 48.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 49.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 66.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.37, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "A Indicator - 85.80% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 47.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.2, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase ,Isoenzymes", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 14.0, "minimum": 12.04, "maximum": 96.9, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.92 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.04 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 36.21, "10th_percentile": 36.21, "90th_percentile": 36.21, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.39 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.65 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Fetal Fibronectin", "code_information": [ { "code": "82731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 666.0, "discounted_cash": 64.0, "minimum": 52.46, "maximum": 632.7, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82.44 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.46 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 65.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 236.43, "10th_percentile": 236.43, "90th_percentile": 236.43, "count": "15" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 123.66 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.45 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 72.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.7, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Indir Qual Ea Reagent Cell", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 190.0, "minimum": 5.72, "maximum": 489.345, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 190.92 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.48 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 200.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 266.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 169.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.23 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspirat/Injection Ganglion Cyst(S)", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1118.8, "discounted_cash": 343.0, "minimum": 112.042, "maximum": 6234.375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 437.32 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 284.64 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 350.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 360.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 480.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 366.09, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 305.3, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1118.8 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 263.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 112.04 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1118.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 350.29, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Biovlbl Testosterone Direct Measurement", "code_information": [ { "code": "84410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316.6, "discounted_cash": 51.0, "minimum": 41.77, "maximum": 300.77, "payers_information": [ { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 65.64 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 53.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 71.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 94.98, "10th_percentile": 94.98, "90th_percentile": 94.98, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.66, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 51.28, "10th_percentile": 51.28, "90th_percentile": 51.28, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.17 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 51.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.31, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Flurazepam - 80346 - 30100014", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.46, "minimum": 11.11, "maximum": 230.337, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.05 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antinuclear Antibodies Titer", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.0, "discounted_cash": 11.0, "minimum": 9.09, "maximum": 137.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.9, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 51.48, "10th_percentile": 51.48, "90th_percentile": 51.48, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.57 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspiration And/Or Injection Thyroid Cyst", "code_information": [ { "code": "60300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2403.2, "discounted_cash": 792.0, "minimum": 256.431, "maximum": 2403.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 939.38 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 611.4 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 831.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1109.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 844.56, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 704.33, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 420.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 256.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2403.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Blood Carbon Dioxide", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.0, "discounted_cash": 4.0, "minimum": 3.98, "maximum": 72.2, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.25 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.98 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.39 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gastrin", "code_information": [ { "code": "82941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 171.0, "discounted_cash": 17.0, "minimum": 14.36, "maximum": 162.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.57 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 19.86 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antistreptolysin O Screen", "code_information": [ { "code": "86063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.9, "discounted_cash": 5.0, "minimum": 4.7, "maximum": 104.405, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.39 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Duodenal Fluid Trypsin", "code_information": [ { "code": "84485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.01, "discounted_cash": 7.0, "minimum": 5.87, "maximum": 111.1595, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.67 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.34, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay For Phencyclidine", "code_information": [ { "code": "83992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.0, "discounted_cash": 20.0, "minimum": 12.17, "maximum": 57.95, "payers_information": [ { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 23.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.42 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.55 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 43.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gentamicin", "code_information": [ { "code": "80170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 234.0, "discounted_cash": 16.0, "minimum": 13.34, "maximum": 222.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.97 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.34 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.46, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.56 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 18.45 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antistreptolysin O Titer", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.0, "discounted_cash": 7.0, "minimum": 5.95, "maximum": 86.45, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.34 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.95 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 32.31, "10th_percentile": 32.31, "90th_percentile": 32.31, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.02 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.84 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 8.22 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay For Calprotectin Fecal", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.66, "discounted_cash": 19.0, "minimum": 15.99, "maximum": 228.627, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 144.4, "10th_percentile": 144.4, "90th_percentile": 144.4, "count": "1 through 10" }, { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.13 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.99 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 72.2, "10th_percentile": 72.2, "90th_percentile": 72.2, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.93, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 85.43, "10th_percentile": 85.43, "90th_percentile": 85.43, "count": "26" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.68 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 22.11 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Galactose Transferase", "code_information": [ { "code": "82775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.67, "discounted_cash": 21.0, "minimum": 5.72, "maximum": 28.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.97 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.16 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 22.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.67 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 23.72 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.49, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Haloperidol", "code_information": [ { "code": "80173", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 234.0, "discounted_cash": 15.0, "minimum": 12.85, "maximum": 222.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.2 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.85 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 16.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt >=100Sqcm Ea Ad 100Sqcm", "code_information": [ { "code": "15278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1265.15, "minimum": 290.0, "maximum": 1265.15, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1265.15 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.04 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1265.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 } ] } ] }, { "description": "Hc Assay Glucose, Body Fluid", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.0, "discounted_cash": 3.0, "minimum": 3.2, "maximum": 67.45, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.03 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 25.21, "10th_percentile": 25.21, "90th_percentile": 25.21, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.53 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.37 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 4.42 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of 5-Hiaa", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.0, "discounted_cash": 12.0, "minimum": 10.5, "maximum": 101.65, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.51 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.75, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.75 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.91 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 14.52 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Hemosiderin, Qual", "code_information": [ { "code": "83070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13.5, "discounted_cash": 4.0, "minimum": 2.69, "maximum": 12.825, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.08 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.88 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 4.79, "10th_percentile": 4.79, "90th_percentile": 4.79, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.52 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.35 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Application Of Finger Splint", "code_information": [ { "code": "29131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 279.7, "discounted_cash": 66.0, "minimum": 54.537, "maximum": 279.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 109.34 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 71.16 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 67.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 69.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 92.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.36, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 58.67, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 279.7 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.95 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 54.54 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 279.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 279.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.32, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Growth Hormone (Hgh)", "code_information": [ { "code": "83003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.0, "discounted_cash": 16.0, "minimum": 13.58, "maximum": 112.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.58 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.77, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.03 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 18.79 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Aldolase", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.0, "discounted_cash": 9.0, "minimum": 7.91, "maximum": 83.6, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.43 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.91 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 31.24, "10th_percentile": 31.24, "90th_percentile": 31.24, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.63 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 10.93 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Homocystine", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.0, "discounted_cash": 17.0, "minimum": 14.61, "maximum": 235.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.61 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.1, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 88.04, "10th_percentile": 88.04, "90th_percentile": 88.04, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.36 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 18.99 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Elbow To Finger Cast", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 653.0, "discounted_cash": 312.0, "minimum": 130.27, "maximum": 653.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 406.29 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 264.45 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 319.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 328.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 438.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.57, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 278.19, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 653.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 367.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 220.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 653.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.18, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acetaminophen - 80329 - 30100036", "code_information": [ { "code": "80329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "minimum": 12.12, "maximum": 190.0, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.52 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amikacin", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.0, "discounted_cash": 15.0, "minimum": 12.28, "maximum": 67.45, "payers_information": [ { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.93 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.44 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.97 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "102.00% 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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.28 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Insulin", "code_information": [ { "code": "83527", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.0, "discounted_cash": 12.0, "minimum": 10.55, "maximum": 59.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.55 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.99 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 14.25 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Arm Cast", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2708.0, "discounted_cash": 312.0, "minimum": 220.598, "maximum": 2708.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 406.29 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 264.45 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 319.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 328.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 438.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.57, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 278.19, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 367.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 220.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2708.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.18, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acetaminophen - G0480 - 30100036", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amitriptyline - G0480 - 30100408", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.24, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Iron", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.0, "discounted_cash": 6.0, "minimum": 5.27, "maximum": 112.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 70.8, "10th_percentile": 70.8, "90th_percentile": 70.8, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.28 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 82.6, "10th_percentile": 82.6, "90th_percentile": 82.6, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 41.89, "10th_percentile": 41.89, "90th_percentile": 41.89, "count": "131" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 57.62, "10th_percentile": 57.62, "90th_percentile": 57.62, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.49 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.29 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Lower Leg Splint", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 605.0, "discounted_cash": 181.0, "minimum": 101.93, "maximum": 605.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 233.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 151.69 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 185.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 190.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 254.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.8, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 161.62, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 605.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 205.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 115.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 605.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 181.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.44, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acth", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 364.0, "discounted_cash": 38.0, "minimum": 31.45, "maximum": 345.8, "payers_information": [ { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.43 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.45 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.17, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 129.22, "10th_percentile": 129.22, "90th_percentile": 129.22, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.16 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.63 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 38.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.39, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ascorbic Acid", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51.0, "discounted_cash": 9.0, "minimum": 8.05, "maximum": 48.45, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.66 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.54, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 18.11, "10th_percentile": 18.11, "90th_percentile": 18.11, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 9.89, "10th_percentile": 9.89, "90th_percentile": 9.89, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.03 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.12 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lipase", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.0, "discounted_cash": 6.0, "minimum": 5.61, "maximum": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 54.0, "10th_percentile": 54.0, "90th_percentile": 54.0, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 63.0, "10th_percentile": 63.0, "90th_percentile": 63.0, "count": "36" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.34, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 31.95, "10th_percentile": 31.95, "90th_percentile": 31.95, "count": "13" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 7.76, "10th_percentile": 7.76, "90th_percentile": 7.76, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.76 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Short Leg Cast", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1047.0, "discounted_cash": 312.0, "minimum": 208.88, "maximum": 1047.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 406.29 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 264.45 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 319.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 328.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 438.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.57, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 278.19, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1047.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 367.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 220.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1047.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 312.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.18, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Androstenedione", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 236.0, "discounted_cash": 29.0, "minimum": 23.85, "maximum": 224.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 141.6, "10th_percentile": 141.6, "90th_percentile": 141.6, "count": "1 through 10" }, { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.48 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.21, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.21 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.47 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 32.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Barbiturates - G0480 - 30100326", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.95, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" } ] } ] }, { "description": "Hc Assay Of Lipoprotein(A)", "code_information": [ { "code": "83695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17.62, "discounted_cash": 14.0, "minimum": 3.52, "maximum": 17.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.62 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.66 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 6.26, "10th_percentile": 6.26, "90th_percentile": 6.26, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.62 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquaporin-4 Antb Cba Each Ea", "code_information": [ { "code": "86052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.05, "discounted_cash": 12.0, "minimum": 2.4, "maximum": 12.05, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Angiotensin Ii", "code_information": [ { "code": "82163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.37, "discounted_cash": 20.0, "minimum": 16.72, "maximum": 238.8015, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.27 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 21.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.87, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.29 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 20.27 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.93, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Benzodiazepines - 80346 - 30100410", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 226.53, "minimum": 11.11, "maximum": 230.337, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.05 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lithium", "code_information": [ { "code": "80178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "discounted_cash": 6.0, "minimum": 5.39, "maximum": 99.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.72 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquaporin-4 Antibody Flow Cytometry Each", "code_information": [ { "code": "86053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.65, "discounted_cash": 37.0, "minimum": 9.41, "maximum": 179.2175, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.42 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.22, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.48, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcium, Ionized", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.0, "discounted_cash": 13.0, "minimum": 11.15, "maximum": 83.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 52.8, "10th_percentile": 52.8, "90th_percentile": 52.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.51 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 61.6, "10th_percentile": 61.6, "90th_percentile": 61.6, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 31.24, "10th_percentile": 31.24, "90th_percentile": 31.24, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 15.39 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Chloride", "code_information": [ { "code": "82435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.0, "discounted_cash": 4.0, "minimum": 3.74, "maximum": 74.1, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.46 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.17 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.89 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.74 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Manganese", "code_information": [ { "code": "83785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.5, "discounted_cash": 26.0, "minimum": 21.69, "maximum": 139.175, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.11 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.69 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 37.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.41, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.15 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.88 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 27.69 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 26.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.18, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Antihuman Globulin Indir Qual Ea Reagent Cell", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 190.0, "minimum": 5.72, "maximum": 489.345, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 190.92 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.48 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 200.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 266.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 169.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.23 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cocaine - 80353 - 30100327", "code_information": [ { "code": "80353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.58, "minimum": 11.11, "maximum": 176.301, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Osmolality", "code_information": [ { "code": "83930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.0, "discounted_cash": 6.0, "minimum": 5.39, "maximum": 50.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.72 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Methemalbumin", "code_information": [ { "code": "83857", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.82, "discounted_cash": 10.0, "minimum": 8.75, "maximum": 152.779, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.75 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.75 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Rh (D)", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.0, "discounted_cash": 41.0, "minimum": 2.99, "maximum": 174.477, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 110.2, "10th_percentile": 39.6, "90th_percentile": 110.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.32 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.56 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 43.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 58.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 128.56, "10th_percentile": 110.2, "90th_percentile": 128.56, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.54, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 37.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 65.2, "10th_percentile": 65.2, "90th_percentile": 65.2, "count": "230" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 11.8, "10th_percentile": 11.8, "90th_percentile": 11.8, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.03 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cpk In Blood", "code_information": [ { "code": "82552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.0, "discounted_cash": 13.0, "minimum": 10.9, "maximum": 53.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.71 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.66, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Carbamazepine Total", "code_information": [ { "code": "80156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 197.0, "discounted_cash": 14.0, "minimum": 11.87, "maximum": 187.15, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.65 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 69.94, "10th_percentile": 69.94, "90th_percentile": 69.94, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.95 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nicotine - G0480 - 30100416", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.95, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Antibody Screen", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.0, "discounted_cash": 58.0, "minimum": 9.77, "maximum": 257.602, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 162.7, "10th_percentile": 162.7, "90th_percentile": 162.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.69 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.53 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 59.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 61.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 189.81, "10th_percentile": 162.7, "90th_percentile": 189.81, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 2032.86, "10th_percentile": 2032.86, "90th_percentile": 2032.86, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.15, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 51.83, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 96.26, "10th_percentile": 96.26, "90th_percentile": 96.26, "count": "228" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 11.84, "10th_percentile": 11.84, "90th_percentile": 11.84, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.23 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.84 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 58.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.47, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Creatinine", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.0, "discounted_cash": 5.0, "minimum": 4.16, "maximum": 58.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 37.2, "10th_percentile": 37.2, "90th_percentile": 37.2, "count": "1 through 10" }, { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.55 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 43.4, "10th_percentile": 43.4, "90th_percentile": 43.4, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 22.01, "10th_percentile": 22.01, "90th_percentile": 22.01, "count": "45" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.83 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.31 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Carnitine", "code_information": [ { "code": "82379", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.0, "discounted_cash": 16.0, "minimum": 12.033, "maximum": 82.65, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.38 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.36 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.03 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nortiptyline - 80335 - 30100013", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 184.4, "minimum": 18.18, "maximum": 208.278, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.03 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreat,Serum Diff Rbc Abso", "code_information": [ { "code": "86978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.5, "discounted_cash": 66.0, "minimum": 12.67, "maximum": 63.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.32 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.56 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 58.67, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.88 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 30.51 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 33.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cryofibrinogen", "code_information": [ { "code": "82585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.48, "discounted_cash": 14.0, "minimum": 6.531, "maximum": 122.056, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.1 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.52 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.58 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 6.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Carotene", "code_information": [ { "code": "82380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.0, "discounted_cash": 9.0, "minimum": 7.51, "maximum": 124.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 9.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.83, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 10.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nortiptyline - G0480 - 30100013", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 184.4, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment,Serum Dilutn", "code_information": [ { "code": "86976", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 32.0, "minimum": 20.09, "maximum": 144.9225, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.58 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.09 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 33.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 45.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 32.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.49, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 28.76, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 32.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 21.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 32.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 61.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Digoxin, Free", "code_information": [ { "code": "80163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.9, "discounted_cash": 13.0, "minimum": 10.82, "maximum": 171.855, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 13.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.52 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ceruloplasmin", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 79.0, "discounted_cash": 10.0, "minimum": 8.75, "maximum": 75.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.75 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.75 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 28.05, "10th_percentile": 28.05, "90th_percentile": 28.05, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Opiates - G0480 - 30100328", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.32, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment,Serum Inhib", "code_information": [ { "code": "86977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 190.0, "minimum": 41.867, "maximum": 489.345, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 190.92 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.48 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 200.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 266.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 169.45, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 168.29 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 41.87 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 52.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Erythropoietin", "code_information": [ { "code": "82668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.0, "discounted_cash": 18.0, "minimum": 15.3, "maximum": 152.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 19.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 56.8, "10th_percentile": 56.8, "90th_percentile": 56.8, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.47 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 21.17 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.17, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ck (Cpk)", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.0, "discounted_cash": 6.0, "minimum": 5.3, "maximum": 91.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 57.6, "10th_percentile": 57.6, "90th_percentile": 57.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 67.2, "10th_percentile": 67.2, "90th_percentile": 67.2, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 34.08, "10th_percentile": 34.08, "90th_percentile": 34.08, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 67.2, "10th_percentile": 67.2, "90th_percentile": 67.2, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.56 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Phenobarbital", "code_information": [ { "code": "80184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 237.0, "discounted_cash": 15.0, "minimum": 12.17, "maximum": 225.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.58 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.31, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthro Hip Wo Anesth", "code_information": [ { "code": "27093", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1409.87, "minimum": 281.27, "maximum": 1409.87, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1409.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1409.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 } ] } ] }, { "description": "Hc Assay Of Estrogen", "code_information": [ { "code": "82672", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.0, "discounted_cash": 21.0, "minimum": 17.67, "maximum": 196.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.78 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.67 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 22.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 30.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.18 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 24.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.13, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Dibucaine Number", "code_information": [ { "code": "82638", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.6, "discounted_cash": 12.0, "minimum": 9.98, "maximum": 158.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.68 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.98 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.86 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 13.79 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Pregnanetriol", "code_information": [ { "code": "84138", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.5, "discounted_cash": 21.0, "minimum": 17.14, "maximum": 163.875, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.94 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 22.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.44, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 21.32 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.47, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Asp/Drain Large Joint/Bursa", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1220.0, "discounted_cash": 343.0, "minimum": 112.042, "maximum": 1220.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 437.32 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 284.64 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 350.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 360.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 480.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 366.09, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 305.3, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1220.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 263.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 112.04 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1220.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 350.29, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethchlorvynol - 80320 - 30100071", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.68, "minimum": 11.11, "maximum": 201.096, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.06 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 21.43, "10th_percentile": 21.43, "90th_percentile": 21.43, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.38 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Digoxin", "code_information": [ { "code": "80162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.0, "discounted_cash": 13.0, "minimum": 10.82, "maximum": 166.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 13.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.52 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 14.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Primidone", "code_information": [ { "code": "80188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 16.0, "minimum": 13.52, "maximum": 128.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.24 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.68, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 18.69 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Biotinidase", "code_information": [ { "code": "82261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22.95, "discounted_cash": 16.0, "minimum": 4.58, "maximum": 22.95, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.03 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethchlorvynol - G0480 - 30100071", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.68, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estriol", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.0, "discounted_cash": 24.0, "minimum": 19.69, "maximum": 112.1, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.95 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.69 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.78, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.21 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 20.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Procalcitonin", "code_information": [ { "code": "84145", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.0, "discounted_cash": 27.0, "minimum": 22.17, "maximum": 235.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.84 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 28.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 38.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 173.6, "10th_percentile": 173.6, "90th_percentile": 173.6, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 30.16 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.76, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Blood Carbon Monoxide", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.0, "discounted_cash": 12.0, "minimum": 10.03, "maximum": 197.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 124.8, "10th_percentile": 124.8, "90th_percentile": 124.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.77 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.03 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.97 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ferritin", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 179.0, "discounted_cash": 13.0, "minimum": 11.1, "maximum": 170.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 107.4, "10th_percentile": 107.4, "90th_percentile": 107.4, "count": "50" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.45 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.1 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 125.3, "10th_percentile": 125.3, "90th_percentile": 125.3, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.53, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 63.55, "10th_percentile": 63.55, "90th_percentile": 63.55, "count": "255" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 87.41, "10th_percentile": 87.41, "90th_percentile": 87.41, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.11 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 15.34 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethanol - G0480 - 30100052", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Progesterone Receptor", "code_information": [ { "code": "84234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286.0, "discounted_cash": 64.0, "minimum": 52.85, "maximum": 271.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 83.05 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.85 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 66.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 68.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 90.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.16, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.21 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 73.05 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 64.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.18, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay For Collagen Cross Links", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.0, "discounted_cash": 18.0, "minimum": 14.364, "maximum": 143.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.91 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Flurazepam - G0480 - 30100014", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.46, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Galactose", "code_information": [ { "code": "82760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.4, "discounted_cash": 11.0, "minimum": 9.12, "maximum": 144.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.34 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.12 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.15 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Prostate Specific Antigen Total - G0103 - 30100312", "code_information": [ { "code": "G0103", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229.0, "discounted_cash": 19.0, "minimum": 19.26, "maximum": 220.1625, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "A Indicator - 85.80% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 82.27, "10th_percentile": 82.27, "90th_percentile": 82.27, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 20.71 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.7, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of 17-Hydroxypregneno", "code_information": [ { "code": "84143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.4, "discounted_cash": 22.0, "minimum": 18.59, "maximum": 235.98, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.2 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.59 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.99 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 24.39 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.27, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ggt", "code_information": [ { "code": "82977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.0, "discounted_cash": 7.0, "minimum": 5.87, "maximum": 112.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 70.8, "10th_percentile": 70.8, "90th_percentile": 70.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 41.89, "10th_percentile": 41.89, "90th_percentile": 41.89, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.67 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.34, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gammaglobulin Iga, Igd, Igg, Igm, Each", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.0, "discounted_cash": 9.0, "minimum": 7.57, "maximum": 117.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 74.4, "10th_percentile": 9.3, "90th_percentile": 148.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.9 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 86.8, "10th_percentile": 86.8, "90th_percentile": 173.6, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 44.02, "10th_percentile": 44.02, "90th_percentile": 88.04, "count": "63" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 8.37 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.49, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Serotonin", "code_information": [ { "code": "84260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 354.0, "discounted_cash": 30.0, "minimum": 25.22, "maximum": 336.3, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.22 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 43.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.02, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.24 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 34.88 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 30.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.94 } ] } ] }, { "description": "Hc Assay Of Aluminum", "code_information": [ { "code": "82108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.67, "discounted_cash": 25.0, "minimum": 6.92, "maximum": 34.67, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.61 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.74 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 34.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.16, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.67 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.67 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 28.69 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Glucagon", "code_information": [ { "code": "82943", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21.0, "discounted_cash": 14.0, "minimum": 4.19, "maximum": 21.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.09 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Haptoglobin, Quant", "code_information": [ { "code": "83010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.0, "discounted_cash": 12.0, "minimum": 10.24, "maximum": 81.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.1 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.24 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 30.53, "10th_percentile": 30.53, "90th_percentile": 30.53, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.39 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 14.16 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Tacrolimus", "code_information": [ { "code": "80197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.0, "discounted_cash": 13.0, "minimum": 8.211, "maximum": 179.55, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.57 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.64, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.26 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.27 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 8.21 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amitriptyline - 80335 - 30100408", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.24, "minimum": 18.18, "maximum": 208.278, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.03 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Inorganic Phosphorus", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.0, "discounted_cash": 4.0, "minimum": 3.87, "maximum": 68.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 43.2, "10th_percentile": 43.2, "90th_percentile": 43.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.07 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.87 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 50.4, "10th_percentile": 50.4, "90th_percentile": 50.4, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 25.56, "10th_percentile": 25.56, "90th_percentile": 25.56, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.68 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Hemoglobin Heat", "code_information": [ { "code": "83065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.56, "discounted_cash": 9.0, "minimum": 7.33, "maximum": 106.932, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.52 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 9.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.59, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.76 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Testosterone", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286.0, "discounted_cash": 25.0, "minimum": 20.74, "maximum": 271.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 171.6, "10th_percentile": 171.6, "90th_percentile": 171.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.6 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.74 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 26.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.15, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 101.53, "10th_percentile": 101.53, "90th_percentile": 101.53, "count": "16" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 25.47, "10th_percentile": 25.47, "90th_percentile": 25.47, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.31 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 28.67 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.98, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ammonia", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.0, "discounted_cash": 14.0, "minimum": 11.87, "maximum": 175.75, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.65 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 129.5, "10th_percentile": 129.5, "90th_percentile": 129.5, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 65.68, "10th_percentile": 65.68, "90th_percentile": 65.68, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.97 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.63 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ketogenic Steroids", "code_information": [ { "code": "83582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.8, "discounted_cash": 15.0, "minimum": 12.61, "maximum": 183.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.61 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Histamine", "code_information": [ { "code": "83088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.0, "discounted_cash": 29.0, "minimum": 19.95, "maximum": 95.0, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.8 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.05 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 31.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 41.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.48, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 35.5, "10th_percentile": 35.5, "90th_percentile": 35.5, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.87 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 33.26 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 29.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Thyroglobulin", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.0, "discounted_cash": 16.0, "minimum": 13.08, "maximum": 86.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.56 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.08 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.04 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 18.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amphetamines - 80324 - 30100323", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.35, "minimum": 11.11, "maximum": 180.8325, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.52 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lead", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 79.0, "discounted_cash": 12.0, "minimum": 9.6, "maximum": 75.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 55.3, "10th_percentile": 55.3, "90th_percentile": 55.3, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 13.64 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Imipramine - 80335 - 30100017", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.78, "minimum": 18.18, "maximum": 208.278, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.03 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Thyroid Stim Immunoglobulins (Tsi)", "code_information": [ { "code": "84445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.0, "discounted_cash": 50.0, "minimum": 38.3, "maximum": 182.4, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 50.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 65.1 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.42 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 51.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 53.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 71.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.22, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 68.16, "10th_percentile": 68.16, "90th_percentile": 68.16, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.46 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 57.27 } ] } ] }, { "description": "Hc Assay Of Amylase", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.0, "discounted_cash": 6.0, "minimum": 5.27, "maximum": 76.0, "payers_information": [ { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.29 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.91, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 28.4, "10th_percentile": 28.4, "90th_percentile": 28.4, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.43 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.51 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.29 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lidocaine", "code_information": [ { "code": "80176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.0, "discounted_cash": 14.0, "minimum": 11.96, "maximum": 74.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.8 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.96 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.66, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.54 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Imipramine - G0480 - 30100017", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.78, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Tobramycin", "code_information": [ { "code": "80200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "discounted_cash": 16.0, "minimum": 13.14, "maximum": 99.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.65 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.15 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 18.15 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Arsenic", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.0, "discounted_cash": 18.0, "minimum": 15.45, "maximum": 105.45, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.28 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.22, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.41 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.76 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 21.37 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lrh Hormone", "code_information": [ { "code": "83727", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.78, "discounted_cash": 17.0, "minimum": 14.0, "maximum": 200.241, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.0 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.32, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.87 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 19.36 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.53, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Insulin,Total", "code_information": [ { "code": "83525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.0, "discounted_cash": 11.0, "minimum": 9.3, "maximum": 92.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 11.43, "10th_percentile": 11.43, "90th_percentile": 58.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.63 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.18, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 34.44, "10th_percentile": 34.44, "90th_percentile": 34.44, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.66, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Topiramate", "code_information": [ { "code": "80201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.0, "discounted_cash": 11.0, "minimum": 9.71, "maximum": 175.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.26 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.71, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.34 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of B Hexosaminidase", "code_information": [ { "code": "83080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 184.0, "discounted_cash": 16.0, "minimum": 12.033, "maximum": 174.8, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.38 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.36 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.03 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Magnesium", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.0, "discounted_cash": 6.0, "minimum": 5.46, "maximum": 106.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 67.2, "10th_percentile": 67.2, "90th_percentile": 67.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.58 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.46 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 78.4, "10th_percentile": 78.4, "90th_percentile": 78.4, "count": "23" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.14, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 39.76, "10th_percentile": 39.76, "90th_percentile": 39.76, "count": "34" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 79.97, "10th_percentile": 79.97, "90th_percentile": 79.97, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.86 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.55 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Interleukin-6 (Il-6)", "code_information": [ { "code": "83529", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.0, "discounted_cash": 17.0, "minimum": 13.49, "maximum": 256.5, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.11 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.41, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Transferrin", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.0, "discounted_cash": 12.0, "minimum": 10.39, "maximum": 112.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.33 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Benzodiazepines - G0480 - 30100410", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 226.53, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 } ] } ] }, { "description": "Hc Assay Of Methadone - G0480 - 30100205", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.98, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ldh Isoenzymes", "code_information": [ { "code": "83625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17.42, "discounted_cash": 12.0, "minimum": 3.48, "maximum": 17.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.37 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.42 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 14.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Creatinine", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.0, "discounted_cash": 5.0, "minimum": 4.23, "maximum": 82.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 52.2, "10th_percentile": 52.2, "90th_percentile": 52.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.63 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 60.9, "10th_percentile": 60.9, "90th_percentile": 60.9, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 30.89, "10th_percentile": 30.89, "90th_percentile": 30.89, "count": "123" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 5.82, "10th_percentile": 5.18, "90th_percentile": 5.82, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.39 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.82 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Fatty Acids", "code_information": [ { "code": "82725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.12, "discounted_cash": 18.0, "minimum": 3.61, "maximum": 18.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.28 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nos Vitamin", "code_information": [ { "code": "84591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.0, "discounted_cash": 17.0, "minimum": 12.34, "maximum": 82.65, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.84 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.89 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 17.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.42 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 13.07 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Neonatal Thyroxine", "code_information": [ { "code": "84437", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.53, "discounted_cash": 6.0, "minimum": 5.27, "maximum": 108.8035, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.28 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.29 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Osmolality", "code_information": [ { "code": "83935", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.0, "discounted_cash": 6.0, "minimum": 5.55, "maximum": 50.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.55 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.27, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.07 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.68 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Lipoprotein,Hdl Cholest", "code_information": [ { "code": "83718", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 148.0, "discounted_cash": 8.0, "minimum": 6.67, "maximum": 140.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.67 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "A Indicator - 85.80% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.29 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 9.22 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.35, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nucleotidase 5'", "code_information": [ { "code": "83915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.0, "discounted_cash": 11.0, "minimum": 9.08, "maximum": 53.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.27 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.55 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.37, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nicotine - 80323 - 30100416", "code_information": [ { "code": "80323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.95, "minimum": 11.11, "maximum": 271.6525, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.92 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Sodium", "code_information": [ { "code": "84300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.0, "discounted_cash": 5.0, "minimum": 4.12, "maximum": 78.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.12 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.88 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Lipoprotein,Ldl Cholest", "code_information": [ { "code": "83721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.0, "discounted_cash": 10.0, "minimum": 8.55, "maximum": 168.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 106.2, "10th_percentile": 106.2, "90th_percentile": 106.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 62.84, "10th_percentile": 62.84, "90th_percentile": 62.84, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.71, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Osteocalcin", "code_information": [ { "code": "83937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21.9, "discounted_cash": 29.0, "minimum": 4.37, "maximum": 21.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Oxalate", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "discounted_cash": 14.0, "minimum": 11.78, "maximum": 99.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.78 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.88 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 14.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.74, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin A", "code_information": [ { "code": "84590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.0, "discounted_cash": 11.0, "minimum": 9.46, "maximum": 61.75, "payers_information": [ { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.38, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 23.08, "10th_percentile": 23.08, "90th_percentile": 23.08, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.82 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 13.07 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.46 } ] } ] }, { "description": "Hc Assay Of C-Peptide", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.0, "discounted_cash": 20.0, "minimum": 16.96, "maximum": 124.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.64 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.96 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.18, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 46.51, "10th_percentile": 46.51, "90th_percentile": 46.51, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.76 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 23.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Phenothiazine - 80342 - 30100385", "code_information": [ { "code": "80342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.71, "minimum": 11.11, "maximum": 181.1745, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Porphyrins Urine Quan&Fxj", "code_information": [ { "code": "84120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.0, "discounted_cash": 14.0, "minimum": 11.98, "maximum": 82.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.83 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.68, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.86 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin B-1", "code_information": [ { "code": "84425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.0, "discounted_cash": 21.0, "minimum": 13.44, "maximum": 104.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.29 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 39.05, "10th_percentile": 39.05, "90th_percentile": 39.05, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 23.91 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.65, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcium In Urine", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.0, "discounted_cash": 6.0, "minimum": 4.91, "maximum": 82.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.72 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.91 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 6.79 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Phenothiazine - G0480 - 30100385", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.71, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Progesterone", "code_information": [ { "code": "84144", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.0, "discounted_cash": 20.0, "minimum": 16.99, "maximum": 147.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 93.0, "10th_percentile": 93.0, "90th_percentile": 93.0, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.7 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.99 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.24, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 55.03, "10th_percentile": 55.03, "90th_percentile": 55.03, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.06 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 23.49 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.28, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Phosphohexose Enzymes", "code_information": [ { "code": "84087", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.55, "discounted_cash": 10.0, "minimum": 8.74, "maximum": 146.8225, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.63 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcium, Total", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.0, "discounted_cash": 5.0, "minimum": 4.21, "maximum": 58.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.21 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 22.01, "10th_percentile": 22.01, "90th_percentile": 22.01, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.36 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.81 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Phenytoin, Total", "code_information": [ { "code": "80185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.0, "discounted_cash": 13.0, "minimum": 10.8, "maximum": 228.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.96 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.48 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 14.93 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Proinsulin", "code_information": [ { "code": "84206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.0, "discounted_cash": 26.0, "minimum": 18.35, "maximum": 87.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.16 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.74 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 28.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 37.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.45, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 32.66, "10th_percentile": 32.66, "90th_percentile": 32.66, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.06 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 20.06 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 26.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Synovial Fluid Mucin", "code_information": [ { "code": "83872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.72, "discounted_cash": 5.0, "minimum": 4.77, "maximum": 106.134, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.5 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.77 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.25, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.98, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Citrate", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 232.0, "discounted_cash": 27.0, "minimum": 22.64, "maximum": 220.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.58 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.64 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 38.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.63, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.09 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 31.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Porphyrins Urine Qual", "code_information": [ { "code": "84119", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 129.14, "discounted_cash": 13.0, "minimum": 8.54, "maximum": 122.683, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.55 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 8.54 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.1 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.88 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.24, "additional_payer_notes": "106.60% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Pyruvate Kinase", "code_information": [ { "code": "84220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.35, "discounted_cash": 9.0, "minimum": 7.69, "maximum": 134.2825, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.08 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.69 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.06, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.11 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 10.63 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Thiopurine S-Methyltransferase", "code_information": [ { "code": "84433", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22.17, "discounted_cash": 22.0, "minimum": 4.42, "maximum": 22.17, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cocaine - G0480 - 30100327", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.58, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Prealbumin", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "discounted_cash": 14.0, "minimum": 11.89, "maximum": 99.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.68 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.89 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.55, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 37.28, "10th_percentile": 37.28, "90th_percentile": 37.28, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.65 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.42 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Rbc Galactokinase", "code_information": [ { "code": "82759", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.16, "discounted_cash": 21.0, "minimum": 17.49, "maximum": 250.002, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.49 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 22.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 30.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 24.19 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.91, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Free Hydroxyproline", "code_information": [ { "code": "83500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.92, "discounted_cash": 22.0, "minimum": 7.17, "maximum": 35.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.99 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 23.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.14, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 25.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Corticosteroids", "code_information": [ { "code": "83491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 17.0, "minimum": 14.58, "maximum": 128.25, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.91 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.58 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.62 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 19.73 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Progesterone 17-D", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 354.0, "discounted_cash": 27.0, "minimum": 22.14, "maximum": 336.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 212.4, "10th_percentile": 212.4, "90th_percentile": 212.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.78 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.14 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 38.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.96, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 125.67, "10th_percentile": 125.67, "90th_percentile": 125.67, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.15 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.06 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 30.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.71, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Renin", "code_information": [ { "code": "84244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.0, "discounted_cash": 21.0, "minimum": 17.91, "maximum": 107.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.15 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.91 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 23.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.66 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 24.77 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.43, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Toxin Or Antitoxin", "code_information": [ { "code": "87230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.1, "discounted_cash": 19.0, "minimum": 16.08, "maximum": 229.995, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.27 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.08 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.04, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.91 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 22.01 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.13, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Corticosterone", "code_information": [ { "code": "82528", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.12, "discounted_cash": 22.0, "minimum": 18.35, "maximum": 232.864, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 31.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.01, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.51 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 25.35 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Pyruvate", "code_information": [ { "code": "84210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.77, "discounted_cash": 14.0, "minimum": 2.95, "maximum": 14.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.77 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.79 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.77, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.77 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.77, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Salicylate - G0480 - 30100044", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" } ] } ] }, { "description": "Hc Assayof Estrogen Receptor", "code_information": [ { "code": "84233", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286.0, "discounted_cash": 87.0, "minimum": 57.06, "maximum": 271.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 112.49 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.58 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 89.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 92.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 123.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.68, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 123.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 72.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 87.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.64, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cyanide", "code_information": [ { "code": "82600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.0, "discounted_cash": 19.0, "minimum": 12.17, "maximum": 57.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.83 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 20.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.68, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.46 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 21.84 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.79, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Quinidine", "code_information": [ { "code": "80194", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.0, "discounted_cash": 14.0, "minimum": 11.89, "maximum": 61.75, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.69 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.89 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.68 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.44 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Serum Potassium", "code_information": [ { "code": "84132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.0, "discounted_cash": 4.0, "minimum": 3.88, "maximum": 74.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 46.8, "10th_percentile": 46.8, "90th_percentile": 46.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.09 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.88 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.07, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 27.69, "10th_percentile": 27.69, "90th_percentile": 27.69, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.46 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.17 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assessment Of Aphasia", "code_information": [ { "code": "96105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 512.0, "discounted_cash": 99.0, "minimum": 78.386, "maximum": 486.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.51 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 104.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 139.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 99.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.91, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 85.24, "additional_payer_notes": "A Indicator - 85.80% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 99.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 99.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 78.39 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 99.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 458.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 168.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 99.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.34, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Doxepin - 80335 - 30100409", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.81, "minimum": 18.18, "maximum": 208.278, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.03 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Salicylate - 80329 - 30100044", "code_information": [ { "code": "80329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "minimum": 12.12, "maximum": 190.0, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.52 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Serum Sodium", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.0, "discounted_cash": 4.0, "minimum": 3.92, "maximum": 74.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 46.8, "10th_percentile": 46.8, "90th_percentile": 46.8, "count": "1 through 10" }, { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.16 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.92 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.25 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Autologous Blood, Op Salvage", "code_information": [ { "code": "86891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2202.65, "discounted_cash": 901.0, "minimum": 21.924, "maximum": 2092.5175, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 901.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 919.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 946.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1261.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 901.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 960.9, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 801.35, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 901.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 901.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 901.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 901.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 901.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 493.63 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 21.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 901.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 901.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 628.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 901.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 266.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 919.44, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Endocrine Hormone", "code_information": [ { "code": "84235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 427.38, "discounted_cash": 71.0, "minimum": 55.65, "maximum": 406.011, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 91.17 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.02 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 72.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 99.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.93, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.56 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 58.93 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 71.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.65, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Silica", "code_information": [ { "code": "84285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 256.32, "discounted_cash": 25.0, "minimum": 20.54, "maximum": 243.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.27 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.54 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 26.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.87, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.17 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 26.51 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.71, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Sex Hormone Binding Globulin", "code_information": [ { "code": "84270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.0, "discounted_cash": 21.0, "minimum": 17.69, "maximum": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.81 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.69 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 30.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.16, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 31.95, "10th_percentile": 31.95, "90th_percentile": 31.95, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 21.73, "10th_percentile": 21.73, "90th_percentile": 21.73, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.24 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 24.47 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.16, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bacterium, Antibody", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.0, "discounted_cash": 12.0, "minimum": 10.49, "maximum": 105.45, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.49 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.72 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estrogens", "code_information": [ { "code": "82671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.5, "discounted_cash": 32.0, "minimum": 12.47, "maximum": 61.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.34 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.31 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 32.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 45.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.43, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 36.37 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 32.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.95, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Theophylline", "code_information": [ { "code": "80198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.0, "discounted_cash": 14.0, "minimum": 11.52, "maximum": 192.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.1 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.52 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.93 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Sialic Acid", "code_information": [ { "code": "84275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.29, "discounted_cash": 13.0, "minimum": 3.65, "maximum": 18.29, "payers_information": [ { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.33, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 15.13 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.94 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bcr/Abl1 Gene Major Bp", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1115.65, "discounted_cash": 163.0, "minimum": 133.53, "maximum": 1059.8675, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.87 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.53 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 167.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 172.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 229.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 630.35, "10th_percentile": 630.35, "90th_percentile": 630.35, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.78, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "A Indicator - 85.80% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.87 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 184.63 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 163.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.24, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethosuximide", "code_information": [ { "code": "80168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22.24, "discounted_cash": 16.0, "minimum": 4.44, "maximum": 22.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.92 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.24 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Thiocyanate", "code_information": [ { "code": "84430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.0, "discounted_cash": 11.0, "minimum": 9.47, "maximum": 67.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.86 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 13.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Somatomedin", "code_information": [ { "code": "84305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.0, "discounted_cash": 21.0, "minimum": 17.31, "maximum": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.31 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.66, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.48 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 19.03 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bile Acids Cholylglycine", "code_information": [ { "code": "82240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 289.36, "discounted_cash": 26.0, "minimum": 21.64, "maximum": 274.892, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.02 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.64 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 27.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 37.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.33, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.1 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 29.93 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 26.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethylene Glycol", "code_information": [ { "code": "82693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54.0, "discounted_cash": 14.0, "minimum": 10.77, "maximum": 51.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.07 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.13 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.88, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.16 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.2, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Total Testosterone", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.0, "discounted_cash": 25.0, "minimum": 21.03, "maximum": 233.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 147.6, "10th_percentile": 147.6, "90th_percentile": 147.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.03 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 36.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 87.33, "10th_percentile": 87.33, "90th_percentile": 87.33, "count": "23" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 25.81, "10th_percentile": 25.81, "90th_percentile": 25.81, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.86 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 29.07 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.33, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Somatostatin", "code_information": [ { "code": "84307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.0, "discounted_cash": 18.0, "minimum": 14.89, "maximum": 136.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.49, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.63 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 19.03 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biliary End Prq Via T-Tube W/Rmvl Calculus", "code_information": [ { "code": "47554", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10885.5, "discounted_cash": 11892.0, "minimum": 1423.0, "maximum": 10885.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10885.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8048.85 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 5238.68 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10885.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 10885.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10885.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10885.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10885.5, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 10572.82, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10885.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2858.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10885.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10885.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10885.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 10885.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3429.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1792.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10885.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 10885.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6315.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1423.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10885.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10885.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10885.5, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Fentanyl - 80354 - 30100020", "code_information": [ { "code": "80354", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.27, "minimum": 12.12, "maximum": 206.4065, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.09 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Total Thyroxine", "code_information": [ { "code": "84436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.0, "discounted_cash": 6.0, "minimum": 5.6, "maximum": 145.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 91.8, "10th_percentile": 91.8, "90th_percentile": 91.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.79 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 7.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.32, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 54.32, "10th_percentile": 54.32, "90th_percentile": 54.32, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.14 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.74 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Sweat Sodium", "code_information": [ { "code": "84302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.3, "discounted_cash": 4.0, "minimum": 3.96, "maximum": 94.335, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.96 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.88 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Of Prostate,Needle/Punch", "code_information": [ { "code": "55700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7532.1, "discounted_cash": 2243.0, "minimum": 519.96, "maximum": 7155.495, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2243.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2944.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1916.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2288.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 2355.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3140.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2243.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2391.39, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1994.32, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2243.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1085.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2243.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2243.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2243.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 2243.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2243.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 2243.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2243.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2243.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2288.2, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Fentanyl - G0480 - 30100020", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.27, "discounted_cash": 114.0, "minimum": 6.77, "maximum": 543.5425, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.19 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 280.0, "10th_percentile": 140.0, "90th_percentile": 280.0, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.98, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Transcortin", "code_information": [ { "code": "84449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 59.0, "discounted_cash": 18.0, "minimum": 11.77, "maximum": 56.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.66 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 18.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% 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": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 19.81 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Thyroxine Bndng Globulin", "code_information": [ { "code": "84442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.0, "discounted_cash": 14.0, "minimum": 12.04, "maximum": 117.8, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.92 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.04 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.39 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.65 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Of Soft Tissues", "code_information": [ { "code": "27040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 1847.0, "minimum": 519.96, "maximum": 4474.405, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1841.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1198.26 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 775.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4082.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Fluoride", "code_information": [ { "code": "82735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.0, "discounted_cash": 18.0, "minimum": 13.97, "maximum": 66.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.73 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.1 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.76, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.06 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 20.87 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.91, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Troponin Qual", "code_information": [ { "code": "84512", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.28, "discounted_cash": 10.0, "minimum": 8.19, "maximum": 109.516, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.92 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.23 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.76, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 8.31 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Triglycerides", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.0, "discounted_cash": 5.0, "minimum": 4.68, "maximum": 61.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.35 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.68 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "A Indicator - 85.80% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.31 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.85, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Of Thyroid,Percut", "code_information": [ { "code": "60100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2403.2, "discounted_cash": 792.0, "minimum": 256.431, "maximum": 2403.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 939.38 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 611.4 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 831.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1109.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 844.56, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 704.33, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 420.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 256.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2403.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 808.12, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Folic Acid, Rbc", "code_information": [ { "code": "82747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.0, "discounted_cash": 17.0, "minimum": 14.37, "maximum": 92.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 58.2, "10th_percentile": 58.2, "90th_percentile": 58.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.59 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.37 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 34.44, "10th_percentile": 34.44, "90th_percentile": 34.44, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Uric Acid, Blood", "code_information": [ { "code": "84550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.0, "discounted_cash": 4.0, "minimum": 3.69, "maximum": 61.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 39.0, "10th_percentile": 39.0, "90th_percentile": 39.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.79 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.69 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 45.5, "10th_percentile": 45.5, "90th_percentile": 45.5, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.82, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 23.08, "10th_percentile": 23.08, "90th_percentile": 23.08, "count": "11" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urobilinogen Urine Quan Tmd Spec", "code_information": [ { "code": "84580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9.66, "discounted_cash": 9.0, "minimum": 1.93, "maximum": 9.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% 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": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.18 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Soft Tissue Back,Deep", "code_information": [ { "code": "21925", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 1847.0, "minimum": 1045.331, "maximum": 6717.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2052.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5685.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1251.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of For Hva", "code_information": [ { "code": "83150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 236.97, "discounted_cash": 22.0, "minimum": 18.25, "maximum": 225.1215, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.68 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.25 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 23.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 31.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.89, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.86, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Uric Acid, Blood, Other Source", "code_information": [ { "code": "84560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.0, "discounted_cash": 5.0, "minimum": 4.13, "maximum": 50.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.13 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.35 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Valproic Acid, Total", "code_information": [ { "code": "80164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 261.0, "discounted_cash": 13.0, "minimum": 11.03, "maximum": 247.95, "payers_information": [ { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.33 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.97 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 15.26 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Soft Tissue Neck/Chest", "code_information": [ { "code": "21550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 1847.0, "minimum": 519.96, "maximum": 4709.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 1841.04 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1198.26 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1494.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 519.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4709.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Free Thyroxine", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.0, "discounted_cash": 9.0, "minimum": 7.35, "maximum": 179.55, "payers_information": [ { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.55 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.35 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 132.3, "10th_percentile": 132.3, "90th_percentile": 132.3, "count": "14" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 67.1, "10th_percentile": 67.1, "90th_percentile": 67.1, "count": "175" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.33 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 10.15, "10th_percentile": 9.02, "90th_percentile": 10.15, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.62 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 10.15 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 113.4, "10th_percentile": 113.4, "90th_percentile": 113.4, "count": "45" }, { "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": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Albumin", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.0, "discounted_cash": 7.0, "minimum": 5.5, "maximum": 30.4, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.96 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.34 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 11.36, "10th_percentile": 11.36, "90th_percentile": 11.36, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.62 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.22 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.82 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vasopressin", "code_information": [ { "code": "84588", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.0, "discounted_cash": 33.0, "minimum": 27.64, "maximum": 197.6, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.44 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.64 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 34.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 35.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 47.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.18, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.16 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.04 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 38.22 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 33.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.62, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bld Clot Factor Viii, Vw Fc Antigen", "code_information": [ { "code": "85246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.0, "discounted_cash": 22.0, "minimum": 18.69, "maximum": 259.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 163.8, "10th_percentile": 163.8, "90th_percentile": 163.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.36 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.69 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 32.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 191.1, "10th_percentile": 191.1, "90th_percentile": 191.1, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 96.92, "10th_percentile": 96.92, "90th_percentile": 96.92, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.19 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 25.84 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Fructose Semen", "code_information": [ { "code": "82757", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.61, "discounted_cash": 17.0, "minimum": 14.12, "maximum": 250.4295, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.2 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.11 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 19.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Alkaloids - 80323 - 30100213", "code_information": [ { "code": "80323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.95, "minimum": 11.11, "maximum": 271.6525, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.92 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin B-2", "code_information": [ { "code": "84252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.75, "discounted_cash": 20.0, "minimum": 16.48, "maximum": 110.9125, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.58, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 41.45, "10th_percentile": 41.45, "90th_percentile": 41.45, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.82 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 22.79 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bld Clot Factor Viii, Vw Fc, Ristocetin Cofactr", "code_information": [ { "code": "85245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.0, "discounted_cash": 22.0, "minimum": 18.69, "maximum": 259.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 163.8, "10th_percentile": 163.8, "90th_percentile": 163.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.36 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.69 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 32.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 191.1, "10th_percentile": 191.1, "90th_percentile": 191.1, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 96.92, "10th_percentile": 96.92, "90th_percentile": 96.92, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.19 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 25.84 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of G6Pd Enzyme", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.0, "discounted_cash": 9.0, "minimum": 7.9, "maximum": 83.6, "payers_information": [ { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.72 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 10.05 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.9 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.58, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Chloride", "code_information": [ { "code": "82436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.0, "discounted_cash": 5.0, "minimum": 4.69, "maximum": 44.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.16 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.66 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Phosphatase Acid Prostatic", "code_information": [ { "code": "84066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.0, "discounted_cash": 9.0, "minimum": 7.87, "maximum": 53.2, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.36 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.53 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.67 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 10.88 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Clot Factor V Test", "code_information": [ { "code": "85220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.56, "discounted_cash": 17.0, "minimum": 12.88, "maximum": 61.332, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.59 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.37 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 22.92, "10th_percentile": 22.92, "90th_percentile": 22.92, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.62 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 19.87 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gammaglobulin Ige", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.0, "discounted_cash": 16.0, "minimum": 13.41, "maximum": 179.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 16.46, "10th_percentile": 16.46, "90th_percentile": 113.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.55, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 67.1, "10th_percentile": 67.1, "90th_percentile": 67.1, "count": "11" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.69 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 18.54 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Hemoglobin", "code_information": [ { "code": "83069", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.7, "discounted_cash": 3.0, "minimum": 3.22, "maximum": 76.665, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.06 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.21, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.56 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 4.45 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.03, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Rbc Protoporphyrin", "code_information": [ { "code": "84202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.0, "discounted_cash": 14.0, "minimum": 11.17, "maximum": 53.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.37 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.69 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 14.35, "10th_percentile": 14.35, "90th_percentile": 14.35, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.26 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.16 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.64, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Clot Factor Viii Test, One Stage", "code_information": [ { "code": "85240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.0, "discounted_cash": 17.0, "minimum": 14.58, "maximum": 259.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 163.8, "10th_percentile": 163.8, "90th_percentile": 163.8, "count": "1 through 10" }, { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.91 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.58 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 191.1, "10th_percentile": 191.1, "90th_percentile": 191.1, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 96.92, "10th_percentile": 96.92, "90th_percentile": 96.92, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.37 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 20.17 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Glucosidase", "code_information": [ { "code": "82963", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.16, "discounted_cash": 21.0, "minimum": 17.49, "maximum": 250.002, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.49 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 22.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 30.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 24.19 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.91, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Sulfate", "code_information": [ { "code": "84392", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.9, "discounted_cash": 5.0, "minimum": 4.47, "maximum": 92.055, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.47 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 5.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.85, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.35 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Tyrosine", "code_information": [ { "code": "84510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.16, "discounted_cash": 10.0, "minimum": 2.82, "maximum": 14.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.16 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.71 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Clot Retraction", "code_information": [ { "code": "85170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.5, "discounted_cash": 16.0, "minimum": 3.84, "maximum": 125.875, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 4.07 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Glutathione", "code_information": [ { "code": "82978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.0, "discounted_cash": 15.0, "minimum": 12.59, "maximum": 184.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.78 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.59 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.47, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.12 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urobilinogen Urine Qual", "code_information": [ { "code": "84578", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.45, "discounted_cash": 4.0, "minimum": 3.46, "maximum": 63.1275, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.64 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.77, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 3.65 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.47 } ] } ] }, { "description": "Hc Assay Urea Nitrogen, Quan", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.0, "discounted_cash": 3.0, "minimum": 3.22, "maximum": 58.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 37.2, "10th_percentile": 37.2, "90th_percentile": 37.2, "count": "1 through 10" }, { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.06 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.21, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 22.01, "10th_percentile": 22.01, "90th_percentile": 22.01, "count": "25" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.56 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 4.45 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.03, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Culture For Bacteria", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.0, "discounted_cash": 10.0, "minimum": 8.4, "maximum": 233.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 147.6, "10th_percentile": 147.6, "90th_percentile": 147.6, "count": "1 through 10" }, { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.21 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 172.2, "10th_percentile": 172.2, "90th_percentile": 172.2, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 87.33, "10th_percentile": 87.33, "90th_percentile": 87.33, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.63 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lactic Acid", "code_information": [ { "code": "83605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.0, "discounted_cash": 11.0, "minimum": 9.43, "maximum": 137.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 87.0, "10th_percentile": 87.0, "90th_percentile": 87.0, "count": "1 through 10" }, { "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.81 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.43 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 51.48, "10th_percentile": 51.48, "90th_percentile": 51.48, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.49 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 12.03, "10th_percentile": 12.03, "90th_percentile": 12.03, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.32 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.03 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Valproic Acid, Free", "code_information": [ { "code": "80165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 184.4, "discounted_cash": 13.0, "minimum": 11.03, "maximum": 175.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.33 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.97 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.81, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Bld/Serum Cholesterol", "code_information": [ { "code": "82465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.0, "discounted_cash": 4.0, "minimum": 3.55, "maximum": 58.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.57 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.55 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.0, "median_amount": 43.4, "10th_percentile": 43.4, "90th_percentile": 43.4, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "A Indicator - 85.80% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 22.01, "10th_percentile": 22.01, "90th_percentile": 22.01, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.06 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 4.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Draw <3 Yrs, Skilled Phys, Scalp", "code_information": [ { "code": "36405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.0, "minimum": 10.703, "maximum": 149.0, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 149.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 10.7 } ] } ] }, { "description": "Hc Assay Of Lap Enzyme", "code_information": [ { "code": "83670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.0, "discounted_cash": 9.0, "minimum": 7.99, "maximum": 62.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.56 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.46, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 9.49 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vip", "code_information": [ { "code": "84586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.0, "discounted_cash": 35.0, "minimum": 16.36, "maximum": 77.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.77 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 37.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.66, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 21.49 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 35.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.04, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Blood Catecholamines", "code_information": [ { "code": "82383", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.56, "discounted_cash": 29.0, "minimum": 23.67, "maximum": 241.832, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.22 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.67 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 30.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 40.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.0, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.62 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 28.22 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 29.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.66, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Fungus Culture", "code_information": [ { "code": "87103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.0, "discounted_cash": 20.0, "minimum": 9.59, "maximum": 245.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.19 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.66 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.88 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 10.15 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Mercury", "code_information": [ { "code": "83825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.0, "discounted_cash": 16.0, "minimum": 13.24, "maximum": 104.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 17.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.33, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.36 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 18.31 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin B-6", "code_information": [ { "code": "84207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.0, "discounted_cash": 28.0, "minimum": 22.88, "maximum": 116.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.97 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.88 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 29.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 39.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.95, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 43.67, "10th_percentile": 43.67, "90th_percentile": 43.67, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.57 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 30.6 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 28.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.66, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Gases O2 Sat Only", "code_information": [ { "code": "82810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54.0, "discounted_cash": 9.0, "minimum": 7.96, "maximum": 51.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.51 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.96 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 10.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% 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": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 9.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Metanephrines", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 309.0, "discounted_cash": 16.0, "minimum": 13.8, "maximum": 293.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.68 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.47 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 19.08 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin E", "code_information": [ { "code": "84446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.0, "discounted_cash": 14.0, "minimum": 11.06, "maximum": 101.65, "payers_information": [ { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.12, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.99 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.15 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.55 } ] } ] }, { "description": "Hc Autoimmune Rheumatoid Arthr, 12 Biomark", "code_information": [ { "code": "81490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.0, "discounted_cash": 840.0, "minimum": 7.78, "maximum": 39.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "A Indicator - 85.80% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Gases: Ph, Po2 & Pco2 W O2 Satu", "code_information": [ { "code": "82805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 308.96, "discounted_cash": 78.0, "minimum": 30.17, "maximum": 293.512, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 100.83 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 80.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 110.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.97, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.46 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 31.95 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 78.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.35, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Methadone - 80358 - 30100205", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.98, "minimum": 11.11, "maximum": 189.981, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.36 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Zinc", "code_information": [ { "code": "84630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.0, "discounted_cash": 11.0, "minimum": 9.27, "maximum": 72.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.58 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.46 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 12.82 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.62, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Autologous Blood Process", "code_information": [ { "code": "86890", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 406.0, "discounted_cash": 190.0, "minimum": 41.867, "maximum": 385.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 190.92 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.48 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 200.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 266.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.19, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 169.45, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 209.82 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 41.87 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.42, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Methemoglobin, Quant", "code_information": [ { "code": "83050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20.5, "discounted_cash": 8.0, "minimum": 4.09, "maximum": 19.475, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.89 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 8.25 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.36, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Myoglobin", "code_information": [ { "code": "83874", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.0, "discounted_cash": 12.0, "minimum": 10.52, "maximum": 134.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.54 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.52 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.77, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 14.55 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Phosphatase Acid, Total", "code_information": [ { "code": "84060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13.95, "discounted_cash": 7.0, "minimum": 2.78, "maximum": 13.95, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.95 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 8.32 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.79, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bacteria Culture Screen", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.0, "discounted_cash": 6.0, "minimum": 5.4, "maximum": 132.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 83.4, "10th_percentile": 83.4, "90th_percentile": 83.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.49 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.4 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 41.7, "10th_percentile": 41.7, "90th_percentile": 41.7, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.07, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 49.35, "10th_percentile": 49.35, "90th_percentile": 49.35, "count": "22" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 48.83, "median_amount": 7.47, "10th_percentile": 7.47, "90th_percentile": 7.47, "count": "1 through 10" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.75 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 7.47 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.76, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Platelet Aggregation", "code_information": [ { "code": "85576", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.0, "discounted_cash": 24.0, "minimum": 15.16, "maximum": 72.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.88 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 26.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 34.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 26.98, "10th_percentile": 26.98, "90th_percentile": 53.96, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.83 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 24.19 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.41, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nickel", "code_information": [ { "code": "83885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266.72, "discounted_cash": 24.0, "minimum": 19.96, "maximum": 253.384, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.37 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.96 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 34.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.13, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.75 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 27.59 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Sngl Organic Acid, Quantitative", "code_information": [ { "code": "83921", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.0, "discounted_cash": 21.0, "minimum": 17.27, "maximum": 207.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 130.8, "10th_percentile": 21.21, "90th_percentile": 130.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.15 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 22.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 77.39, "10th_percentile": 77.39, "90th_percentile": 77.39, "count": "20" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.85 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 18.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.63, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bactericidal Level Serum", "code_information": [ { "code": "87197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.61, "discounted_cash": 15.0, "minimum": 12.24, "maximum": 173.4795, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.23 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.01, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.36 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Smear Interpretation", "code_information": [ { "code": "85060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.94, "minimum": 13.776, "maximum": 112.993, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.25 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.97 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 13.78 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.56 } ] } ] }, { "description": "Hc Assay Of Opiates - 80361 - 30100328", "code_information": [ { "code": "80361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.32, "minimum": 13.13, "maximum": 226.404, "payers_information": [ { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.33 }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Test For Blood Fecal", "code_information": [ { "code": "82274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.85, "discounted_cash": 15.0, "minimum": 12.98, "maximum": 185.1075, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.8 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 16.69 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.38 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.98 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.97, "additional_payer_notes": "106.60% of Medicare Rates" } ] } ] }, { "description": "Hc Balloon Dilat Ureteral Stricture W/Img Gdn Rs&I", "code_information": [ { "code": "50706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4098.0, "minimum": 290.0, "maximum": 3893.1, "payers_information": [ { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3774.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 } ] } ] }, { "description": "Hc Blood Sulfhemoglobin Assay", "code_information": [ { "code": "83060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.75, "discounted_cash": 8.0, "minimum": 7.17, "maximum": 117.5625, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.26 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.17 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 9.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 9.31 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.98, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Parathormone", "code_information": [ { "code": "83970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 443.0, "discounted_cash": 41.0, "minimum": 33.62, "maximum": 420.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.84 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.62 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 57.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 157.27, "10th_percentile": 157.27, "90th_percentile": 157.27, "count": "11" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.94 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 46.48 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 41.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Total Hydroxyproline", "code_information": [ { "code": "83505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.72, "discounted_cash": 24.0, "minimum": 19.8, "maximum": 251.484, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.1 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 25.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 34.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.9, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.42 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 27.38 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.79, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bartonella Dna Quant", "code_information": [ { "code": "87472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 349.74, "discounted_cash": 42.0, "minimum": 34.9, "maximum": 332.253, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.84 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.9 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.67, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.22 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.45 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 48.24 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.7, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Type Antigen Donor Reagent Serum, Ea Ag", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.02, "discounted_cash": 401.0, "minimum": 4.06, "maximum": 103.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 103.02 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.02 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 146.29, "10th_percentile": 109.72, "90th_percentile": 219.43, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.02 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 21.92 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.02, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Phenytoin, Free", "code_information": [ { "code": "80186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.0, "discounted_cash": 13.0, "minimum": 11.2, "maximum": 81.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.67, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.32 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Urine Urea-N", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.0, "discounted_cash": 5.0, "minimum": 4.52, "maximum": 78.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.7 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 5.35 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bartonella, Antibody", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 10.0, "minimum": 8.3, "maximum": 96.9, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.03 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.3 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.52 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood/Lymph System Procedure", "code_information": [ { "code": "38999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1914.5, "discounted_cash": 493.0, "minimum": 256.431, "maximum": 1914.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 493.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 643.33 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 444.14 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 503.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 518.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 691.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 493.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 526.17, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 438.8, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1541.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 493.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 315.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 493.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 493.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 493.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 493.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 593.3 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 256.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 493.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 493.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1914.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 290.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 493.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 493.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 503.46, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Plasma Hemoglobin", "code_information": [ { "code": "83051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.56, "discounted_cash": 7.0, "minimum": 2.51, "maximum": 11.932, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.96 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.79, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.46, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Vit D, 1,25-Dihydroxy W Fractions", "code_information": [ { "code": "82652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.0, "discounted_cash": 38.0, "minimum": 31.36, "maximum": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 171.0, "10th_percentile": 171.0, "90th_percentile": 171.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.28 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.36 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 40.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 53.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.04, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 35.5, "median_amount": 101.18, "10th_percentile": 101.18, "90th_percentile": 101.18, "count": "1 through 10" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.43 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 43.36 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 38.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.27, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Basic Metabolic Panel Calcium Ionized", "code_information": [ { "code": "80047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 213.0, "discounted_cash": 13.0, "minimum": 8.99, "maximum": 202.35, "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": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.57 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.64, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.25 }, { "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": "Traditional Medicare AD-HOC", "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": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.03 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 9.53 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC 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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bone Biopsy,Trocar/Needle Deep", "code_information": [ { "code": "20225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 1847.0, "minimum": 1045.331, "maximum": 6717.83, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 2764.12 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "case rate", "standard_charge_dollar": 1799.06 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1884.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 1940.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2586.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.81, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 1642.74, "additional_payer_notes": "88.90% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1900.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1494.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.41 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "methodology": "fee schedule", "standard_charge_dollar": 1045.33 }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5510.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1183.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1847.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Porphobilinogen Urine Quan", "code_information": [ { "code": "84110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.0, "discounted_cash": 8.0, "minimum": 6.87, "maximum": 39.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.8 }, { "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87 }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "106.60% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare AD-HOC", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "methodology": "fee schedule", "standard_c